On the ASN (American Society of Nephrology) Podcast, the host, David White, talked with Dr. Kenar Jhaveri, associate chief of nephrology at Northwell Health, about his recent study on acute kidney injury (AKI) in patients hospitalized with COVID-19.*

COVID-19 in New York

Northwell Health has 23 hospitals, including academic and community hospitals, that serve both urban and suburban areas in metropolitan New York. Before March 2020, the Division of Kidney Diseases and Hypertension focused mainly on amyloidosis, cardio-renal syndrome, kidney transplantation, and other related diseases. 

This department, however, quickly turned into the center for COVID-19 treatment. COVID-19 is a disease caused by the virus called coronavirus, or SARS-CoV-2. While COVID-19 is primarily a respiratory virus, it also affects other organs, such as the kidneys. Acute kidney injury (AKI) is when the kidneys suddenly fail or sudden kidney damage occurs—causing the kidneys to become unable to filter waste products out.

What they did 

Researchers reviewed the health records of patients who were hospitalized between March 1 and April 5, 2020, with COVID-19 at 13 different academic and community Northwell Health hospitals for signs of AKI.

What they found

• Of 5,449 patients with COVID-19, 1,993 patients (36.6%) developed AKI.
• Of those 1,993 patients with AKI, 46.5% were in stage 1, 22.4% were in stage 2, and 31.1% were in stage 3.
• Of the patients who developed AKI, 14.3% of them required renal replacement therapy (RRT).
• AKI was most common in COVID-19 patients with respiratory failure. 89.7% of patients on mechanical ventilation developed AKI compared to 21.7% of non-ventilated patients.
• 276 of 285 (96.8%) of the patients who needed RRT were on ventilators.
• By the end of the study, 694 patients had died (35%), 519 (26%) were discharged, and 780 (39%) were still in the hospital.

Moreover, the study found that COVID-19 patients with AKI have a high frequency of acute tubular necrosis (ATN). ATN is a medical condition that causes damage to kidney tubule cells, which reabsorb fluid and minerals as urine forms, and it is one of the most common causes of AKI.  

What it means

AKI is highly prevalent among patients with COVID-19. It happens early on, is associated with respiratory failure, and typically has a poor prognosis. The highest risk factors for AKI in COVID-19 patients are age (older), race (black), diabetes mellitus (DM), cardiovascular disease, hypertension, and a need to be on ventilation.

For those interested, you can find the full Kidney International study, “Acute kidney injury in patients hospitalized with COVID-19,” on their website.

*White, D. (Host). (2020, June 16). Acute Kidney Injury and COVID-19. [Audio podcast].