Acute kidney injury in patients with COVID-19: a retrospective cohort study from Switzerland

BACKGROUND: Data about patients in Europe with corona virus disease-2019 (COVID-19) and acute kidney injury (AKI) are scarce. We examined characteristics, presentation and risk factors of AKI in patients hospitalised with COVID-19 in a tertiary hospital in Switzerland. METHODS: We reviewed health records of patients hospitalised with a positive nasopharyngeal polymerase chain reaction test for SARS-CoV2 between 1 February and 30 June 2020, at the University Hospital of Basel. The nadir creatinine of the hospitalisation was used as baseline. AKI was defined according the KDIGO guidelines as a 1.5x increase of baseline creatinine and in-hospital renal recovery as a discharge creatinine <1.25x baseline creatinine. Least absolute shrinkage and selection operator (LASSO) regression was performed to select predictive variables of AKI. Based on this a final model was chosen. RESULTS: Of 188 patients with COVID-19, 41 (22%) developed AKI, and 11 (6%) required renal replacement therapy. AKI developed after a median of 9 days (interquartile range [IQR] 5-12) after the first symptoms and a median of 1 day (IQR 0-5) after hospital admission. The peak AKI stages were stage 1 in 39%, stage 2 in 24% and stage 3 in 37%. A total of 29 (15%) patients were admitted to the intensive care unit and of these 23 (79%) developed AKI. In-hospital renal recovery at discharge was observed in 61% of all AKI episodes. In-hospital mortality was 27% in patients with AKI and 10% in patients without AKI. Age (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 1.01-1.08; p = 0.024), history of chronic kidney disease (aOR 3.47, 95% CI 1.16-10.49;p = 0.026), C-reactive protein levels (aOR 1.09, 95% CI 1.03-1.06; p = 0.002) and creatinine kinase (aOR 1.03, 95% CI 1.01-1.06; p = 0.002) were associated with development of AKI. CONCLUSIONS: AKI is common in hospitalised patients with COVID-19 and more often seen in patients with severe COVID-19 illness. AKI is associated with a high in-hospital mortality.

Automated summary

Data on AKI in European COVID-19 patients are limited. A study in a Swiss tertiary hospital found AKI to be common in hospitalized COVID-19 patients, especially those with severe illness. Risk factors for AKI included age, history of chronic kidney disease, C-reactive protein levels, and creatinine kinase.