AKI in COVID-19 patients and history of cancer: Role of d-dimer as a potential risk factor

Background: New York City (NYC) was the epicenter of the coronavirus disease 19 (COVID-19) pandemic in the United States in the Spring of 2020. Complications of severe COVID-19 infection included ARDS, thrombotic events and acute kidney injury (AKI). Patients with co-morbidities such as diabetes mellitus, heart failure, chronic kidney disease and cancer had higher mortality rates. The rate of AKI in NYC was between 37%-46% in hospitalized patients. In this study we determined the role of coagulation activation as assessed by D-Dimer as a risk factor for AKI in COVID-19 patients with history of cancer. Methods: We used the MSKCC electronic medical records to obtain patient data. We included all patients above 18 years of age who were hospitalized at MSKCC for COVID-19 infection and had a confirmed positive RT-PCR nasopharyngeal swab test for SARs-CoV2 between March 1, 2020 to May 1, 2020. Patents with ESRD on dialysis were excluded. Results: We had a total of 361 patients with COVID-19 infection who were hospitalized and of these 25.7% (93/361) required admission to the intensive care unit (ICU). AKI developed in 9% (33/361) of patients and of these 69% (23/33) developed AKI after ICU admission. 26 patients who developed AKI had D-dimer levels checked and 88.4% of these patients had an elevated D-dimer vs 34.5% (67/194) positivity rate for patients with no AKI (p= 1.4e-7). D-dimer and AKI association shown in Figure 1. Conclusions: The rate of AKI in our population was significantly lower than in general population despite having history of active or treated cancer as a comorbidity. The majority of patients developed AKI after admission to the ICU. An elevated D-dimer was noted in 88.4% of patient who developed AKI and were tested for it. This could make D-Dimer a risk marker for AKI in cancer patients with COVID-19.