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. 2020 May;97(5):829-838.
doi: 10.1016/j.kint.2020.03.005. Epub 2020 Mar 20.

Kidney disease is associated with in-hospital death of patients with COVID-19

Yichun Cheng  1 , Ran Luo  1 , Kun Wang  1 , Meng Zhang  1 , Zhixiang Wang  1 , Lei Dong  1 , Junhua Li  1 , Ying Yao  1 , Shuwang Ge  2 , Gang Xu  3
Affiliations

Kidney disease is associated with in-hospital death of patients with COVID-19

Yichun Cheng et al. Kidney Int. 2020 May.

Abstract

In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (interquartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m2 were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan-Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.

Keywords: COVID-19; acute kidney injury; in-hospital death; kidney disease; pneumonia.

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Figures

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Graphical abstract
Figure 1
Figure 1
Cumulative incidence of acute kidney injury of patients with coronavirus disease 2019 subgrouped by baseline serum creatinine.
Figure 2
Figure 2
Cumulative incidence for in-hospital death of patients with coronavirus disease 2019 subgrouped by kidney disease indicators. Shadows indicate the 95% confidence intervals of the corresponding estimates: (a) proteinuria, (b) hematuria, (c) baseline blood urea nitrogen (BUN), (d) baseline serum creatinine, (e) peak serum creatinine, and (f) acute kidney injury.
Figure 3
Figure 3
Association of kidney disease with in-hospital death in patients with coronavirus disease 2019 (COVID-19). Hazard ratios (HRs) of each variable were obtained using separate proportional hazard Cox models after adjustment for age, sex, disease severity, any comorbidity, and lymphocyte count. The severity was staged based on the guidelines for diagnosis and treatment of COVID-19 (trial fifth edition) published by the Chinese National Health Commission on February 4, 2020. Comorbidities include chronic kidney disease, chronic obstructive pulmonary disease, hypertension, diabetes, and tumor. 95% CI, 95% confidence interval.
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