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Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak.
Nephrol Dial Transplant. 2020 08 01; 35(8):1353-1361.ND

Abstract

BACKGROUND

Novel coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread, affecting >10 million cases worldwide. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and primarily manifesting as an acute respiratory failure with interstitial and alveolar pneumonia, it can also affect multiple organs. Kidney involvement was underestimated in early reports and its role remains controversial. The aim of this study was to analyse the role of kidney damage in COVID-19 outcome.

METHODS

This is a prospective cohort study of 1603 consecutive patients admitted in a University Reference Hospital in the heart of the European outbreak.

RESULTS

Median age was 64 years, 40.4% were female, 15.2% presented diabetes mellitus, 35.7% hypertension and 20.3% obesity. On admission, the prevalence of elevated serum creatinine (sCr), proteinuria, leucocyturia and haematuria were 21.0, 37.8, 31.8 and 45.6%, respectively. In total, 43.5% of those with an elevated sCr had previous chronic kidney disease (CKD) and 11.4% of those with normal sCr developed an in-hospital acute kidney injury (AKI); 17 patients needed acute haemodialysis; and 197 patients died during hospitalization. Cox proportional hazard regression confirmed that elevated baseline sCr [hazard ratio (95% confidence interval) 2.40 (1.79-3.22)], previous CKD [1.59 (1.06-2.37)], haematuria [1 + 1.68 (0.92-3.06), 2-3 + 2.69 (1.49-4.87)] and in-hospital AKI [1.50 (0.92-2.44)] were independent risk factors for in-hospital death after adjusting for age, sex and comorbidity.

CONCLUSION

The prevalence of acute and chronic kidney disease on admission and in-hospital AKI is higher than previously reported in Wuhan, and is associated with high in-hospital mortality. We should increase our awareness towards kidney involvement and design specific strategies for management of COVID-19 in these patients.

Authors+Show Affiliations

Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain. Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain.Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain. Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain.Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain.Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain. Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain.Internal Medicine Department-Infectious, Diseases University Hospital Puerta de Hierro, Madrid, Spain.Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain.Pneumology Department, University Hospital Puerta de Hierro, Madrid, Spain.Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain. Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain.Internal Medicine Department-Infectious, Diseases University Hospital Puerta de Hierro, Madrid, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32871592

Citation

Portolés, Jose, et al. "Chronic Kidney Disease and Acute Kidney Injury in the COVID-19 Spanish Outbreak." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 35, no. 8, 2020, pp. 1353-1361.
Portolés J, Marques M, López-Sánchez P, et al. Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak. Nephrol Dial Transplant. 2020;35(8):1353-1361.
Portolés, J., Marques, M., López-Sánchez, P., de Valdenebro, M., Muñez, E., Serrano, M. L., Malo, R., García, E., & Cuervas, V. (2020). Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 35(8), 1353-1361. https://doi.org/10.1093/ndt/gfaa189
Portolés J, et al. Chronic Kidney Disease and Acute Kidney Injury in the COVID-19 Spanish Outbreak. Nephrol Dial Transplant. 2020 08 1;35(8):1353-1361. PubMed PMID: 32871592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak. AU - Portolés,Jose, AU - Marques,María, AU - López-Sánchez,Paula, AU - de Valdenebro,María, AU - Muñez,Elena, AU - Serrano,María Luisa, AU - Malo,Rosa, AU - García,Estefanya, AU - Cuervas,Valentín, PY - 2020/05/05/received PY - 2020/06/22/accepted PY - 2020/9/2/entrez PY - 2020/9/2/pubmed PY - 2020/9/2/medline KW - COVID-19 KW - SARS-CoV-2 KW - acute kidney injury KW - chronic kidney disease KW - outcomes SP - 1353 EP - 1361 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 35 IS - 8 N2 - BACKGROUND: Novel coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread, affecting >10 million cases worldwide. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and primarily manifesting as an acute respiratory failure with interstitial and alveolar pneumonia, it can also affect multiple organs. Kidney involvement was underestimated in early reports and its role remains controversial. The aim of this study was to analyse the role of kidney damage in COVID-19 outcome. METHODS: This is a prospective cohort study of 1603 consecutive patients admitted in a University Reference Hospital in the heart of the European outbreak. RESULTS: Median age was 64 years, 40.4% were female, 15.2% presented diabetes mellitus, 35.7% hypertension and 20.3% obesity. On admission, the prevalence of elevated serum creatinine (sCr), proteinuria, leucocyturia and haematuria were 21.0, 37.8, 31.8 and 45.6%, respectively. In total, 43.5% of those with an elevated sCr had previous chronic kidney disease (CKD) and 11.4% of those with normal sCr developed an in-hospital acute kidney injury (AKI); 17 patients needed acute haemodialysis; and 197 patients died during hospitalization. Cox proportional hazard regression confirmed that elevated baseline sCr [hazard ratio (95% confidence interval) 2.40 (1.79-3.22)], previous CKD [1.59 (1.06-2.37)], haematuria [1 + 1.68 (0.92-3.06), 2-3 + 2.69 (1.49-4.87)] and in-hospital AKI [1.50 (0.92-2.44)] were independent risk factors for in-hospital death after adjusting for age, sex and comorbidity. CONCLUSION: The prevalence of acute and chronic kidney disease on admission and in-hospital AKI is higher than previously reported in Wuhan, and is associated with high in-hospital mortality. We should increase our awareness towards kidney involvement and design specific strategies for management of COVID-19 in these patients. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/32871592/Chronic_kidney_disease_and_acute_kidney_injury_in_the_COVID_19_Spanish_outbreak_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfaa189 DB - PRIME DP - Unbound Medicine ER -