Morbid obesity, hypertension, and male sex are associated with greater risk for AKI in patients with COVID-19

Background: Acute kidney injury (AKI) is a manifestation of COVID-19 (CoVAKI) However, there is paucity of data from United States, particularly in a predominantly African American (AA) population We report the phenotype and outcomes of AKI at an academic hospital in New Orleans Methods: We conducted an observational study in patients hospitalized at Ochsner Medical Center over 1-month period with COVID-19 and diagnosis of AKI by KDIGO We examined the rates of renal replacement therapy (RRT) and in-hospital mortality as outcome measures Adjudication of cause of AKI was independently performed via manual chart review by 3 study team members Results: Of 644 admissions with COVID-19, 69 were excluded due to ESRD or kidney transplant Thus, 575 patients entered the cohort [173 (28%) to an intensive care unit (ICU)] Patients were predominantly AA (71%) AKI was diagnosed in 161 patients (28% overall, 61% of ICU admissions), median age 65 (34 - 96), predominantly male (62%) and hypertensive (83%) Median follow up was 25 (1 - 45) days Vasopressors and/or mechanical ventilation was required in 105 (65%) of them In-hospital mortality rate for those with AKI was 50% (80/181) De novo AKI was diagnosed in 65%, whereas AKI over preexisting chronic kidney disease occurred in 35% of the cohort Ninetyone (57%) patients arrived with AKI, whereas the remaining 43% acquired AKI during the hospitalization [median hospital day of AKI onset: 4 (2 - 10)] RRT was required in 89/161 (55%) and 77/105 (73%) patients for all AKI cases and the ICU subset, respectively The mortality rate for those with AKI-RRT was 72% (64/89) Hemodynamic instability leading to ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of the etiology, respectively Reversible prerenal azotemia occurred in 9% In 13%, no obvious cause of AKI was identified aside from the COVID-19 diagnosis Three (1 8%) patients had De novo collapsing glomerulopathy Conclusions: CoV-AKI is associated with high rates of RRT, ICU care and death Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting, but other etiologies contribute to the overall AKI burden