Acute kidney injury in coronavirus disease and association with thrombosis

Introduction: Coronavirus disease (COVID-19) is a global pandemic which continues to cause systemic inflammation leading to multi-system organ damage including acute kidney injury (AKI) and thrombotic complications. We hypothesize that D-dimer level predicts an increased risk of acute kidney injury and thrombotic complications in COVID-19. Methods: This was a retrospective cohort study performed at a single center academic center. Patients hospitalized with COVID-19 between Jan 1, 2020 through Jan 1, 2021 were included in the analysis. Demographics and associated medical records were reviewed from the electronic medical record. Statistical analysis was done to determine the incidence of AKI and thrombosis and if D-dimer was predictive of an adverse event. Results: The study included 389 patients with the diagnosis of COVID-19 who were hospitalized. Acute kidney injury was evident in 143 patients with 59 experiencing a thrombotic event. Factors associated with acute kidney injury included: age, chronic kidney disease, proteinuria, use of out-patient angiotensin blocking medications and D-dimer greater than 1.75 (p < 0.05). Factors associated with thrombosis included: use of outpatient anti-coagulants, elevated WBC, interleukin-6 (IL-6) and D-dimer greater than 1.75 (p< 0.05). When D-dimer was dichotomized at the median value for the entire data set (value greater than 1.75), there was good discrimination for AKI and very good discrimination for thrombosis. Discussion/Conclusions: Complications of acute renal failure and thrombosis are common in patients presenting with COVID-19. D-dimer was found to be predictive of both. Future studies to validate the association of these two events in patients presenting with COVID-19 are warranted as early treatment with antithrombotic agents may have a role in preventing adverse sequelae and outcomes.