Kidney injury seen in one-third of hospitalized virus patients

A large-scale study out of New York’s Northwell Health adds to the evidence that kidney injury is linked to COVID-19 hospitalizations. Doctors across the Northwell hospital system reported an “alarming amount” of hospitalized coronavirus patients developed acute kidney injury (AKI) during the height of the pandemic. 

A team of investigators at Feinstein Institutes for Medical Research analyzed the electronic health records (EHR) of 5,449 hospitalized COVID-19 patients between March 1, 2020, and April 5, 2020. They found that 1,993 patients — 36.6% — developed AKI, according to the study published in Kidney International. 

When the study concluded, 39.1% of the patients with AKI were still hospitalized — that’s 780 out of 1,993 people.

Most cases of AKI were developed early in a patient’s COVID-19 hospitalization. About 37% either arrived at the hospital with AKI or developed it within 24 hours.

AKI, a sudden episode of kidney failure or damage, prevents waste from being filtered within the body and can often lead to death, according to the study. About 14% of patients with AKI required dialytic support at some point during their hospitalization.

The researchers also found a “substantial” link between respiratory failure and AKI. Nearly 90% of patients who required mechanical ventilation developed AKI. Only 21.7% of non-ventilated patients developed it. 

About 23% of patients who required mechanical ventilation developed AKI and required dialysis therapy — compared to just 0.2% (9 of 4,259) of non-ventilated patients.

Researchers say the rates of kidney injury are higher than reported from China, according to new data.

The increase of AKI cases during the coronavirus pandemic brought New York hospitals’ dialysis services to a breaking point. While some health care facilities were scrambling to get more ventilators, others reported shortages of crucial dialysis equipment. 

Dr. Michele Mokrzycki, a nephrologist at the Montefiore Medical Center in the Bronx, spoke to CBSN about the crisis in April. Due to a shortage in dialysis machines, Mokrzycki said physicians at Montefiore had to adapt to using other procedures, like peritoneal dialysis.

“One other thing that contributed to this is that, for coronavirus patients, you don’t want to dialyze these patients in your dialysis unit because that exposes other patients in the unit to the virus,” Mokrzycki told CBSN. Therefore, these patients required dialysis in their individual rooms, which meant one-to-one nursing. This tripled the hospitals’ demand for nurses, Mokrzycki said.

Because of a shortage of nurses, who were also getting sick from COVID-19, the hospital experienced what Mokrzycki called a “perfect storm.”

Mokrzycki said the hospital has never seen anything this severe. “Unfortunately, we’re seeing a very abrupt rise in the kidney toxin levels within a period days,” she said, adding the kidney injuries were believed to be caused by viral invasion into the cells, or low oxygen levels in the kidney. 

The Northwell study also revealed risk factors for developing AKI, including age, diabetes,  cardiovascular disease and hypertension. The team also also found that black patients were at increased risk for developing AKI.

Kenar D. Jhaveri, MD, a researcher at the Feinstein Institutes and corresponding author of the paper, said the team hopes to learn more about the COVID-19-related AKI in the coming weeks.

Kevin J. Tracey, MD, CEO and president of the Feinstein Institutes said Dr. Jhaveri’s findings “highlights the danger of kidney injury in this setting, an important new insight into this disease.”