COVID-19-related acute kidney injury; temporal changes in incidence rate and outcomes in a large UK cohort

Abstract Background: Acute kidney injury (AKI) is common among patients hospitalised with COVID-19, and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. Methods: We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. Results: Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2,and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24-4,18; p<0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27-2.53; p<0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19-2.13) for stage 1; p<0.005, 2.71(95%CI 1.82-4.05); p<0.001for stage 2 and 2.99 (95%CI 2.17-4.11); p<0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. Conclusions: This large UK cohort demonstrated a high AKI incidence with a changing pattern over time and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3-6 months.