Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology.

Autor: Arikan H; Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey., Ozturk S; Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey., Tokgoz B; Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey., Dursun B; Department of Internal Medicine, Division of Nephrology, Pamukkale University Medical School, Denizli, Turkey., Seyahi N; Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey., Trabulus S; Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey., Islam M; Division of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey., Ayar Y; Division of Nephrology, Bursa City Hospital, Faculty of Medicine, University of Health Sciences, Bursa, Turkey., Gorgulu N; Department of Nephrology, Istanbul Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Karadag S; Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey., Gok M; Department of Nephrology, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey., Akcali E; Department of Nephrology, Mersin University Faculty of Medicine, Mersin, Turkey., Bora F; Department of Internal Medicine, Division of Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey., Aydın Z; Department of Nephrology, Kocaeli Darica Farabi Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey., Altun E; Division of Nephrology, Golcuk Necati Celik State Hospital, Kocaeli, Turkey., Ahbap E; Department of Nephrology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey., Polat M; Division of Nephrology, Nevsehir State Hospital, Nevsehir, Turkey., Soypacacı Z; Department of Nephrology, Ataturk Training and Research Hospital, University of Katip Celebi, Izmir, Turkey., Oguz EG; Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey., Koyuncu S; Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey., Colak H; Division of Nephrology, Tepecik Education and Research Hospital University of Health Sciences, İzmir, Turkey., Sahin İ; Department of Internal Medicine, Division of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey., Dolarslan ME; Division of Nephrology, Trabzon Kanuni Education and Research Hospital, University of Health Sciences, Trabzon, Turkey., Helvacı O; Division of Nephrology, Yenimahalle Research and Training Hospital, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey., Kurultak I; Department of Nephrology, Trakya University Faculty of Medicine, Edirne, Turkey., Eren Z; Department of Nephrology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey., Dheir H; Department of Internal Medicine, Division of Nephrology, Sakarya University Medical Faculty Education and Research Hospital, Sakarya, Turkey., Ogutmen MB; Division of Nephrology, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey., Taymez DG; Nephrology and Dialysis Department, Kocaeli State Hospital, Kocaeli, Turkey., Genek DG; Department of Nephrology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey., Ozkurt S; Department of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey., Bakır EA; Department of Nephrology, Bahcesehir University Hospital, Istanbul, Turkey., Yuksel E; Department of Nephrology, Gaziyasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey., Sahutoglu T; Nephrology Unit, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey., Oto OA; Department of Internal Medicine, Division of Nephrology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey., Boz G; Division of Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey., Sengul E; Division of Nephrology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey., Kara E; Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey., Tuglular S; Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Aug 10; Vol. 16 (8), pp. e0256023. Date of Electronic Publication: 2021 Aug 10 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0256023
Abstrakt: Background: Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.
Methods: In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.
Results: The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality.
Conclusions: Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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