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Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System.
Cardiorenal Med. 2020; 10(4):223-231.CM

Abstract

INTRODUCTION

Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population.

METHODS

This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI.

RESULTS

Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032).

CONCLUSION

We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

Authors+Show Affiliations

Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA, pelayoje@einstein.edu.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA. Division of Pulmonary and Critical Care and Sleep Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA. Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA. Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32554965

Citation

Pelayo, Jerald, et al. "Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury With COVID-19 in a US Inner City Hospital System." Cardiorenal Medicine, vol. 10, no. 4, 2020, pp. 223-231.
Pelayo J, Lo KB, Bhargav R, et al. Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System. Cardiorenal Med. 2020;10(4):223-231.
Pelayo, J., Lo, K. B., Bhargav, R., Gul, F., Peterson, E., DeJoy Iii, R., Salacup, G. F., Albano, J., Gopalakrishnan, A., Azmaiparashvili, Z., Patarroyo-Aponte, G., & Rangaswami, J. (2020). Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System. Cardiorenal Medicine, 10(4), 223-231. https://doi.org/10.1159/000509182
Pelayo J, et al. Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury With COVID-19 in a US Inner City Hospital System. Cardiorenal Med. 2020;10(4):223-231. PubMed PMID: 32554965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System. AU - Pelayo,Jerald, AU - Lo,Kevin Bryan, AU - Bhargav,Ruchika, AU - Gul,Fahad, AU - Peterson,Eric, AU - DeJoy Iii,Robert, AU - Salacup,Grace Faith, AU - Albano,Jeri, AU - Gopalakrishnan,Akshaya, AU - Azmaiparashvili,Zurab, AU - Patarroyo-Aponte,Gabriel, AU - Rangaswami,Janani, Y1 - 2020/06/18/ PY - 2020/05/13/received PY - 2020/06/01/accepted PY - 2020/6/20/pubmed PY - 2020/7/18/medline PY - 2020/6/20/entrez KW - Acute kidney injury KW - COVID-19 KW - Heart failure KW - Novel coronavirus SP - 223 EP - 231 JF - Cardiorenal medicine JO - Cardiorenal Med VL - 10 IS - 4 N2 - INTRODUCTION: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. METHODS: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. RESULTS: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032). CONCLUSION: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19. SN - 1664-5502 UR - https://www.unboundmedicine.com/medline/citation/32554965/Clinical_Characteristics_and_Outcomes_of_Community__and_Hospital_Acquired_Acute_Kidney_Injury_with_COVID_19_in_a_US_Inner_City_Hospital_System_ L2 - https://www.karger.com?DOI=10.1159/000509182 DB - PRIME DP - Unbound Medicine ER -