Background: COVID-19 is a multi-organ system disease, and rates of acute kidney injury (AKI) have varied significantly. Our objective was to evaluate the prevalence of AKI among hospitalized COVID-19-positive patients in a large hospital system in the Southeast of the USA.
Materials and methods: This was a cohort study of admitted patients discharged between March 1, 2020 and April 30, 2020 at Atrium Health who had tested positive for COVID-19 by polymerase chain reaction testing of a nasopharyngeal swab. The positive test had been within 2 weeks prior to or after admission. AKI was defined and staged using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 AKI criteria. Patient-level data including demographic characteristics, Charlson Comorbidity Index, and other comorbidities were also obtained.
Results: Of the admitted patients with COVID-19, 74 of 254 (29.1%, 95% CI 23.6 - 35.1%) had AKI. Participants with AKI compared to those without AKI tended to be ≥ 65 years of age (57 vs. 39%; p = 0.01), male (62 vs. 46%; p = 0.02), African American (70 vs. 45%; p < 0.01), have a diagnosis of chronic kidney disease (28 vs. 15%; p = 0.01), and a higher median Charlson Comorbidity Index score (6.5 vs. 4.0; p < 0.01). After adjusting for other factors, African Americans had three times the odds of developing AKI compared to other racial groups among patients admitted with a COVID-19 diagnosis (OR 3.09; 95% CI 1.49 - 6.41).
Conclusion: Among the 254 patients hospitalized with COVID-19, we observed a high prevalence of AKI. However, a majority of survivors demonstrated renal recovery at the time of discharge. African American race was strongly associated with development of AKI and portended a poor prognosis.