Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan

Chen, Kehong; Lei, Yu; He, Yani; Xiao, Fei; Yu, Yan; Lai, Xiaodong; Liu, Yang; Wang, Jiang; Dai, Huanzi

Renal injury is common in patients with coronavirus disease 2019 (COVID‐19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60–89 vs. < 60 mL/min/1.73 m(2)). The risk of reaching the composite endpoint—intensive care unit admission, invasive ventilation, or death—was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m(2)), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m(2)). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan–Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m(2) or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m(2)) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.