Suyuan Peng1,2, Huai-Yu Wang1,2, Xiaoyu Sun1, Pengfei Li3, Zhanghui Ye3, Qing Li3, Jinwei Wang4, Xuanyu Shi1, Liu Liu5, Ying Yao5,6, Rui Zeng5, Fan He5, Junhua Li5, Shuwang Ge5, Xianjun Ke7, Zhibin Zhou7, Erdan Dong8,9,10,11, Haibo Wang12, Gang Xu5, Luxia Zhang1,3,4, Ming-Hui Zhao4,13. 1. National Institute of Health Data Science, Peking University, Beijing, China. 2. School of Public Health, Peking University, Beijing, China. 3. Advanced Institute of Information Technology, Peking University, Hangzhou, China. 4. Department of Medicine, Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China. 5. Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 6. Department of Clinical Nutrition, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 7. Taikang Tongji (Wuhan) Hospital, Wuhan, China. 8. Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China. 9. Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China. 10. Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China. 11. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China. 12. Clinical Trials Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. 13. Peking-Tsinghua Center for Life Sciences, Beijing, China.
Abstract
BACKGROUND: Acute kidney injury (AKI) is an important complication of coronavirus disease 2019 (COVID-19), which could be caused by both systematic responses from multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI as well as their risk factors and the association with mortality. METHODS: Consecutive hospitalized patients with COVID-19 in tertiary hospitals in Wuhan, China from 1 January 2020 to 23 March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with in-hospital mortality were analyzed. RESULTS: A total of 4020 cases with laboratory-confirmed COVID-19 were included and 285 (7.09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with an increased risk of in-hospital mortality, with similar fully adjusted hazard ratios of 2.46 [95% confidence interval (CI) 1.35-4.49] for AKI-early and 3.09 (95% CI 2.17-4.40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early. While age, history of chronic kidney disease and the levels of inflammatory biomarkers were associated with the risk of AKI-late. CONCLUSIONS: AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during COVID-19.
BACKGROUND:Acute kidney injury (AKI) is an important complication of coronavirus disease 2019 (COVID-19), which could be caused by both systematic responses from multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI as well as their risk factors and the association with mortality. METHODS: Consecutive hospitalized patients with COVID-19 in tertiary hospitals in Wuhan, China from 1 January 2020 to 23 March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with in-hospital mortality were analyzed. RESULTS: A total of 4020 cases with laboratory-confirmed COVID-19 were included and 285 (7.09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with an increased risk of in-hospital mortality, with similar fully adjusted hazard ratios of 2.46 [95% confidence interval (CI) 1.35-4.49] for AKI-early and 3.09 (95% CI 2.17-4.40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early. While age, history of chronic kidney disease and the levels of inflammatory biomarkers were associated with the risk of AKI-late. CONCLUSIONS: AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during COVID-19.
Authors: Christopher Bitcon; Stewart Whalen; Jenna Coleman; Ricardo Rendon; Greg Bailly; David Bell; Ashley Cox; Jon Duplisea; Karthik Tenankore; Ross Mason Journal: Ann Surg Oncol Date: 2022-04-05 Impact factor: 5.344
Authors: A Cau; M P Cheng; Terry Lee; A Levin; T C Lee; D C Vinh; F Lamontagne; J Singer; K R Walley; S Murthy; D Patrick; O Rewa; B Winston; J Marshall; J Boyd; J A Russell Journal: Can J Kidney Health Dis Date: 2021-10-30
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Authors: Rajit K Basu; Erica C Bjornstad; Katja M Gist; Michelle Starr; Paras Khandhar; Rahul Chanchlani; Kelli A Krallman; Michael Zappitelli; David Askenazi; Stuart L Goldstein Journal: Pediatr Res Date: 2021-07-30 Impact factor: 3.953