Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Research Letters
Open Access

Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center

John R. Lee, Jeffrey Silberzweig, Oleh Akchurin, Mary E. Choi, Vesh Srivatana, Jonathan Lin, Frank Liu, Line Malha, Michelle Lubetzky, Darshana M. Dadhania, Divya Shankaranarayanan, Daniil Shimonov, Sanjay Neupane, Thalia Salinas, Aarti Bhasin, Elly Varma, Lorenz Leuprecht, Supriya Gerardine, Perola Lamba, Parag Goyal, Eric Caliendo, Victoria Tiase, Rahul Sharma, Joel C. Park, Peter A.D. Steel, Manikkam Suthanthiran and Yiye Zhang
CJASN September 2020, CJN.07440520; DOI: https://doi.org/10.2215/CJN.07440520
John R. Lee
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
2Department of Transplantation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeffrey Silberzweig
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
3The Rogosin Institute, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Oleh Akchurin
3The Rogosin Institute, New York, New York
4Division of Pediatric Nephrology, Department of Pediatrics, Weill Cornell Medicine, New York, New York
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Oleh Akchurin
Mary E. Choi
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mary E. Choi
Vesh Srivatana
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
3The Rogosin Institute, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Vesh Srivatana
Jonathan Lin
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
3The Rogosin Institute, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Frank Liu
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
3The Rogosin Institute, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Frank Liu
Line Malha
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michelle Lubetzky
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
2Department of Transplantation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Darshana M. Dadhania
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
2Department of Transplantation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Divya Shankaranarayanan
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Daniil Shimonov
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sanjay Neupane
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thalia Salinas
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Aarti Bhasin
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elly Varma
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lorenz Leuprecht
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Supriya Gerardine
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Perola Lamba
5NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Parag Goyal
6Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eric Caliendo
7Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Victoria Tiase
8The Value Institute, NewYork-Presbyterian Hospital, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rahul Sharma
9Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joel C. Park
9Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter A.D. Steel
9Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Manikkam Suthanthiran
1Division of Nephrology and Hypertension, Weill Cornell Medicine, NewYork, New York
2Department of Transplantation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yiye Zhang
9Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
10Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading
  • acute renal failure
  • COVID-19
  • acute kidney injury
  • Academic Medical Centers

AKI is a recognized complication of coronavirus disease 2019 (COVID-19) (1). In this study, we characterized the AKI incidence and outcomes in patients with COVID-19 and AKI.

We conducted a retrospective cohort study of 1002 patients admitted from March 1 to April 19, 2020 through the Emergency Department at NewYork-Presbyterian/Weill Cornell Medical Center. Patient follow-up was until at least June 20, 2020, at which time 22 patients were still hospitalized and nine were transferred to another hospital facility. Baseline creatinine was defined as the closest creatinine prior to March 1, 2020 or, if none was available, the creatinine at time of hospital presentation. The Weill Cornell Institutional Review Board approved this study.

AKI, defined by the Kidney Disease Improving Global Outcomes criteria (2), occurred in 294 (29%) of the 1002 patients: stage 1 AKI (n=182, 18%); stage 2 AKI (n=29, 3%); and stage 3 AKI (n=83, 8%). KRT was performed in 59 patients (6%); 53 received hemodialysis and/or continuous venovenous hemodialysis, five received a combination of acute peritoneal dialysis and hemodialysis/continuous venovenous hemodialysis, and one received acute peritoneal dialysis. The time from hospitalization to AKI was a median of 2.2 days in stage 1 AKI, 2.4 days in stage 2 AKI, and 1.6 days in stage 3 AKI.

We evaluated the urine electrolytes and microscopy associated with the AKI event within 3 days. Among those available, the fractional excretion of sodium (FENa) was <1% in 76%, and urine microscopy had granular casts in 21%. The presumed etiology of stage 3 AKI on the basis of manual chart review was acute tubular necrosis (ATN) in 28%, prerenal in 13%, prerenal/ATN in 11%, other causes in 4%, and unknown in 45% of patients. Granular casts were observed more frequently in stage 3 AKI than stage 1 AKI and stage 2 AKI (33% versus 16%, P=0.006).

We compared clinical characteristics of the patients with AKI with those without AKI (Table 1). Patients who developed AKI were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, CKD, and kidney transplantation than patients without AKI (P<0.001). Proteinuria and hematuria were more frequent in patients with AKI than in patients without AKI (P<0.001). Baseline creatinine, admission creatinine, peak creatinine, white blood cells, procalcitonin, troponin I, C-reactive protein, d-dimer, ferritin, lactate dehydrogenase, lactate, and creatine kinase were significantly higher in patients with AKI than in patients without AKI (P<0.001), whereas hemoglobin and albumin levels were significantly lower in patients with AKI than in those without AKI (P<0.001). Patients with AKI were also more likely to have usage of nonsteroidal anti-inflammatory drugs, diuretics, and hydroxychloroquine during hospitalization; intensive care unit admission; mechanical ventilation; use of vasopressors; and longer hospital length of stay than patients without AKI (P<0.001).

View this table:
  • View inline
  • View popup
Table 1.

For continuous variable, the numbers of measurements are listed (n = number in total cohort/number in AKI group/number in the no AKI group)

Patients with AKI had higher mortality than patients without AKI (40% versus 8%, P<0.001). Among the patients with AKI, 140 (48%) recovered to their baseline kidney function. Among the 154 (52%) who did not recover to their baseline kidney function, 43 received dialysis, among which 34 were dialysis dependent and 26 died (60%), and 111 did not receive dialysis, among which 80 (72%) died (P=0.18). Patients with AKI who did not recover to their baseline kidney function were older; had more congestive heart failure; had less anticoagulation use; and had higher d-dimer, troponin I, and peak creatinine levels than patients with AKI who recovered to their baseline kidney function (P<0.001).

Within the AKI group, we found that the FENa was <1% in a majority of patients, and granular casts were present in 21% of patients. However, another study found that FENa was <1% in 38% of cases of patients with AKI and COVID-19 (3), and therefore, FENa evaluation needs to be interpreted with due caution and may not reflect the AKI etiology. As for potential etiology for the AKI, limited data from patient series of kidney biopsies support ATN as the most common cause of AKI (4). Further studies are needed to better understand the basis for kidney dysfunction.

In this study, we found several laboratory parameters that are significantly different between patients with AKI and patients without AKI. d-dimer level was significantly higher in patients with AKI without kidney function recovery than in patients with AKI and kidney function recovery. A recent study in patients with COVID-19 admitted to the intensive care unit reported d-dimer as predictive of the need for dialysis (5), and it is likely that d-dimer is a predictor of disease severity. We also found a higher IL-6 level in patients with AKI than in patients without AKI. Whether cytokine storm also played a role in kidney injury is unknown. Disease severity may also be linked to men, and further evaluation is needed to understand the relationship between sex and AKI. An important limitation of our study is that the incidence of community-acquired AKI may have been underestimated because only one-third of patients had a baseline creatinine prior to admission.

In conclusion, our study identified a high incidence of AKI in hospitalized patients with COVID-19. We found that a significant proportion did not have complete kidney function recovery, supporting the importance of CKD follow-up in patients with COVID-19.

Disclosures

O. Akchurin reports receiving a grant from the National Institutes of Health and is a recipient of the Clinical Scholar Award from Weill Cornell Medicine. M. Choi reports receiving grants from the National Institutes of Health. D. Dadhania reports receiving advisory board fees from AlloVir Inc., CareDx, and Veloxis Pharm. D. Dadhania, J. Lee, and M. Suthanthiran have filed patent US-2020-0048713-A1 titled “Methods of detecting cell-free DNA in biological samples.” J. Lee reports receiving a grant from BioFire Diagnostics LLC, grants from the National Institutes of Health, and a grant from the National Kidney Foundation. F. Liu reports receiving advisory board fees from Accordant and is on the speakers’ bureau on Janssen Pharmaceuticals. V. Srivatana reports receiving speakers’ fees from Baxter Healthcare. M. Suthanthiran reports receiving grants from CareDx, Inc. and the National Institutes of Health and consultant fees from CareDx, Inc. and Sparks Therapeutics. Y. Zhang reports other from Iris OB Health, Inc. and grants from the Agency for Healthcare Research and Quality, the National Institutes of Health, and the US Department of Transportation, outside the submitted work. All remaining authors have nothing to disclose.

Funding

This study received support from NewYork-Presbyterian Hospital and Weill Cornell Medical College, including the Clinical and Translational Science Center (National Center for Advancing Translational Sciences grant UL1 TR000457) and Joint Clinical Trials Office.

Acknowledgments

We thank all of the hospital staff at NewYork-Presbyterian Hospital for their highly dedicated care of patients with COVID-19. We thank the following Weill Cornell Medicine medical students for their contributions to the COVID-19 Registry through medical chart abstraction: Ms. Zara Adamou, Ms. Haneen Aljayyousi, Mr. Mark N. Alshak (student leader), Mr. Bryan K. Ang, Ms. Elena Beideck, Dr. Orrin S. Belden, Mr. Anthony F. Blackburn, Mr. Joshua W. Bliss, Ms. Kimberly A. Bogardus, Ms. Chelsea D. Boydstun, Ms. Clare A. Burchenal, Mr. Eric T. Caliendo, Mr. John K. Chae, Mr. David L. Chang, Mr. Frank R. Chen, Mr. Kenny Chen, Mr. Andrew Cho, Ms. Alice Chung, Ms. Alisha N. Dua, Mr. Andrew Eidelberg, Mr. Rahmi S. Elahjji, Mr. Mahmoud Eljalby, Ms. Emily R. Eruysal, Ms. Kimberly N. Forlenza, Ms. Rana Khan Fowlkes, Ms. Rachel L. Friedlander, Mr. Gary George, Ms. Shannon Glynn, Ms. Leora Haber, Ms. Janice Havasy, Mr. Alex Huang, Mr. Hao Huang, Ms. Jennifer H. Huang, Ms. Sonia Iosim, Ms. Mitali Kini, Ms. Rohini V. Kopparam, Mr. Jerry Y. Lee, Mr. Mark Leek, Ms. Aretina K. Leung, Mr. Han A. Li (student leader), Ms. Bethina Liu, Ms. Charalambia Louka, Ms. Brienne Lubor, Ms. Dianne Lumaquin, Mr. Matthew L. Magruder, Ms. Ruth Moges, Ms. Prithvi M. Mohan, Mr. Max F. Morin, Ms. Sophie Mou, Mr. J.J. Nario, Ms. Yuna Oh, Mr. Noah Rossen, Dr. Emma M. Schatoff, Ms. Pooja D. Shah, Mr. Sachin P. Shah, Mr. Daniel Skaf, Mr. Shoran Tamura, Mr. Ahmed Toure, Ms. Camila M. Villasante, Mr. Gal Wald, Mr. Graham T. Wehmeyer (student leader), Mr. Samuel Williams, Ms. Ashley Wu, Mr. Andrew L. Yin, and Ms. Lisa Zhang.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Copyright © 2021 by the American Society of Nephrology

References

    1. Hirsch JS,
    2. Ng JH,
    3. Ross DW,
    4. Sharma P,
    5. Shah HH,
    6. Barnett RL,
    7. Hazzan AD,
    8. Fishbane S,
    9. Jhaveri KD; Northwell COVID-19 Research Consortium
    : Acute kidney injury in patients hospitalized with COVID-19. Kidney Int 98: 209–218, 2020 pmid:32416116
    OpenUrlCrossRefPubMed
    1. KDIGO Work Group
    : Section 2: AKI definition. Kidney Int Suppl (2011) 2: 19–36, 2012
    OpenUrlCrossRef
    1. Mohamed MM,
    2. Lukitsch I,
    3. Torres-Ortiz AE,
    4. Walker JB,
    5. Varghese V,
    6. Hernandez-Arroyo CF,
    7. Alqudsi M,
    8. LeDoux JR,
    9. Velez JCQ
    : Acute kidney injury associated with coronavirus disease 2019 in urban New Orleans. Kidney360 1: 614–622, 2020
    OpenUrlAbstract/FREE Full Text
    1. Sharma P,
    2. Uppal NN,
    3. Wanchoo R,
    4. Shah HH,
    5. Yang Y,
    6. Parikh R,
    7. Khanin Y,
    8. Madireddy V,
    9. Larsen CP,
    10. Jhaveri KD,
    11. Bijol V; Northwell Nephrology COVID-19 Research Consortium
    : COVID-19-associated kidney injury: A case series of kidney biopsy findings. J Am Soc Nephrol 31: 1948–1958, 2020 pmid:32660970
    OpenUrlAbstract/FREE Full Text
    1. Wright FL,
    2. Vogler TO,
    3. Moore EE,
    4. Moore HB,
    5. Wohlauer MV,
    6. Urban S,
    7. Nydam TL,
    8. Moore PK,
    9. McIntyre RC Jr..
    : Fibrinolysis shutdown correlation with thromboembolic events in severe COVID-19 infection. J Am Coll Surg 231: 193–203.e1, 2020 pmid:32422349
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology: 16 (1)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 1
January 07, 2021
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center
John R. Lee, Jeffrey Silberzweig, Oleh Akchurin, Mary E. Choi, Vesh Srivatana, Jonathan Lin, Frank Liu, Line Malha, Michelle Lubetzky, Darshana M. Dadhania, Divya Shankaranarayanan, Daniil Shimonov, Sanjay Neupane, Thalia Salinas, Aarti Bhasin, Elly Varma, Lorenz Leuprecht, Supriya Gerardine, Perola Lamba, Parag Goyal, Eric Caliendo, Victoria Tiase, Rahul Sharma, Joel C. Park, Peter A.D. Steel, Manikkam Suthanthiran, Yiye Zhang
CJASN Sep 2020, CJN.07440520; DOI: 10.2215/CJN.07440520

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center
John R. Lee, Jeffrey Silberzweig, Oleh Akchurin, Mary E. Choi, Vesh Srivatana, Jonathan Lin, Frank Liu, Line Malha, Michelle Lubetzky, Darshana M. Dadhania, Divya Shankaranarayanan, Daniil Shimonov, Sanjay Neupane, Thalia Salinas, Aarti Bhasin, Elly Varma, Lorenz Leuprecht, Supriya Gerardine, Perola Lamba, Parag Goyal, Eric Caliendo, Victoria Tiase, Rahul Sharma, Joel C. Park, Peter A.D. Steel, Manikkam Suthanthiran, Yiye Zhang
CJASN Sep 2020, CJN.07440520; DOI: 10.2215/CJN.07440520
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Disclosures
    • Funding
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

  • Uromodulin, Salt, and 24-Hour Blood Pressure in the General Population
  • Anticoagulation Strategies and Filter Life in COVID-19 Patients Receiving Continuous Renal Replacement Therapy
  • COVID-19 in Peritoneal Dialysis Patients
Show more Research Letters

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Keywords

  • acute renal failure
  • COVID-19
  • acute kidney injury
  • Academic Medical Centers

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire