Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

Elisa Russo, Pasquale Esposito, Lucia Taramasso, Laura Magnasco, Michela Saio, Federica Briano, Chiara Russo, Silvia Dettori, Antonio Vena, Antonio Di Biagio, Giacomo Garibotto, Matteo Bassetti, Francesca Viazzi, GECOVID working group, Anna Alessandrini, Marco Camera, Emanuele Delfino, Andrea De Maria, Chiara Dentone, Antonio Di Biagio, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Malgorzata Mikulska, Laura Ambra Nicolini, Federica Toscanini, Daniele Roberto Giacobbe, Antonio Vena, Lucia Taramasso, Elisa Balletto, Federica Portunato, Eva Schenone, Nirmala Rosseti, Federico Baldi, Marco Berruti, Federica Briano, Silvia Dettori, Laura Labate, Laura Magnasco, Michele Mirabella, Rachele Pincino, Chiara Russo, Giovanni Sarteschi, Chiara Sepulcri, Stefania Tutino, Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola Pitto, Kassem Salam, Angelo Gratarola, Mattia Bixio, Annalisa Amelia, Andrea Balestra, Paola Ballarino, Nicholas Bardi, Roberto Boccafogli, Francesca Fezza, Elisa Calzolari, Marta Castelli, Elisabetta Cenni, Paolo Cortese, Giuseppe Cuttone, Sara Feltrin, Stefano Giovinazzo, Patrizia Giuntini, Letizia Natale, Davide Orsi, Matteo Pastorino, Tommaso Perazzo, Fabio Pescetelli, Federico Schenone, Maria Grazia Serra, Marco Sottano, Roberto Tallone, Massimo Amelotti, Marie Jeanne Majabò, Massimo Merlini, Federica Perazzo, Nidal Ahamd, Paolo Barbera, Marta Bovio, Paola Vacca, Andrea Collidà, Ombretta Cutuli, Agnese Lomeo, Francesca Fezza Nicola Gentilucci, Nadia Hussein, Emanuele Malvezzi, Laura Massobrio, Giula Motta, Laura Pastorino, Nicoletta Pollicardo, Stefano Sartini, Paola Vacca Valentina Virga, Italo Porto, Giampaolo Bezante, Roberta Della Bona, Giovanni La Malfa, Alberto Valbusa, Vered Gil Ad, Emanuela Barisione, Michele Bellotti, Aloe' Teresita, Alessandro Blanco, Marco Grosso, Maria Grazia Piroddi, Paolo Moscatelli, Paola Ballarino, Matteo Caiti, Elisabetta Cenni, Patrizia Giuntini, Ottavia Magnani, Samir Sukkar, Ludovica Cogorno, Raffaella Gradaschi, Erica Guiddo, Eleonora Martino, Livia Pisciotta, Bruno Cavaliere, Rossi Cristina, Farina Francesca, Giacomo Garibotto, Pasquale Esposito, Giovanni Passalacqua, Diego Bagnasco, Fulvio Braido, Annamaria Riccio, Elena Tagliabue, Claudio Gustavino, Antonella Ferraiolo, Salvatore Giuffrida, Nicola Rosso, Alessandra Morando, Riccardo Papalia, Donata Passerini, Gabriella Tiberio, Giovanni Orengo, Alberto Battaglini, Silvano Ruffoni, Sergio Caglieris, Mauro Giacomini, Sara Mora, Elisa Russo, Pasquale Esposito, Lucia Taramasso, Laura Magnasco, Michela Saio, Federica Briano, Chiara Russo, Silvia Dettori, Antonio Vena, Antonio Di Biagio, Giacomo Garibotto, Matteo Bassetti, Francesca Viazzi, GECOVID working group, Anna Alessandrini, Marco Camera, Emanuele Delfino, Andrea De Maria, Chiara Dentone, Antonio Di Biagio, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Malgorzata Mikulska, Laura Ambra Nicolini, Federica Toscanini, Daniele Roberto Giacobbe, Antonio Vena, Lucia Taramasso, Elisa Balletto, Federica Portunato, Eva Schenone, Nirmala Rosseti, Federico Baldi, Marco Berruti, Federica Briano, Silvia Dettori, Laura Labate, Laura Magnasco, Michele Mirabella, Rachele Pincino, Chiara Russo, Giovanni Sarteschi, Chiara Sepulcri, Stefania Tutino, Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola Pitto, Kassem Salam, Angelo Gratarola, Mattia Bixio, Annalisa Amelia, Andrea Balestra, Paola Ballarino, Nicholas Bardi, Roberto Boccafogli, Francesca Fezza, Elisa Calzolari, Marta Castelli, Elisabetta Cenni, Paolo Cortese, Giuseppe Cuttone, Sara Feltrin, Stefano Giovinazzo, Patrizia Giuntini, Letizia Natale, Davide Orsi, Matteo Pastorino, Tommaso Perazzo, Fabio Pescetelli, Federico Schenone, Maria Grazia Serra, Marco Sottano, Roberto Tallone, Massimo Amelotti, Marie Jeanne Majabò, Massimo Merlini, Federica Perazzo, Nidal Ahamd, Paolo Barbera, Marta Bovio, Paola Vacca, Andrea Collidà, Ombretta Cutuli, Agnese Lomeo, Francesca Fezza Nicola Gentilucci, Nadia Hussein, Emanuele Malvezzi, Laura Massobrio, Giula Motta, Laura Pastorino, Nicoletta Pollicardo, Stefano Sartini, Paola Vacca Valentina Virga, Italo Porto, Giampaolo Bezante, Roberta Della Bona, Giovanni La Malfa, Alberto Valbusa, Vered Gil Ad, Emanuela Barisione, Michele Bellotti, Aloe' Teresita, Alessandro Blanco, Marco Grosso, Maria Grazia Piroddi, Paolo Moscatelli, Paola Ballarino, Matteo Caiti, Elisabetta Cenni, Patrizia Giuntini, Ottavia Magnani, Samir Sukkar, Ludovica Cogorno, Raffaella Gradaschi, Erica Guiddo, Eleonora Martino, Livia Pisciotta, Bruno Cavaliere, Rossi Cristina, Farina Francesca, Giacomo Garibotto, Pasquale Esposito, Giovanni Passalacqua, Diego Bagnasco, Fulvio Braido, Annamaria Riccio, Elena Tagliabue, Claudio Gustavino, Antonella Ferraiolo, Salvatore Giuffrida, Nicola Rosso, Alessandra Morando, Riccardo Papalia, Donata Passerini, Gabriella Tiberio, Giovanni Orengo, Alberto Battaglini, Silvano Ruffoni, Sergio Caglieris, Mauro Giacomini, Sara Mora

Abstract

Background: The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients.

Methods: We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death.

Results: Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21-2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively).

Conclusion: Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.

Keywords: Acute kidney injury; COVID-19; Chronic kidney disease; Mortality; Proteinuria.

Conflict of interest statement

The authors declare they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The number of patients with diagnosis of acute kidney injury by length of hospitalization
Fig. 2
Fig. 2
Kaplan Maier curves of survival without death for COVID-19 patients on the basis of chronic kidney disease and/or acute kidney injury. Log Rank test p AKI acute kidney injury, CKD chronic kidney disease

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