Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy
Authors: Russo Elisa , Esposito Pasquale , Taramasso Lucia , Magnasco Laura , Saio Michela , Briano Federica , Russo Chiara , Dettori Silvia , Vena Antonio , Di Biagio Antonio , Garibotto Giacomo , Bassetti Matteo , Viazzi Francesca ,   GECOVID working group, Alessandrini Anna , Camera Marco , Delfino Emanuele , De Maria Andrea , Dentone Chiara , Di Biagio Antonio , Dodi Ferdinando , Ferrazin Antonio , Mazzarello Giovanni , Mikulska Malgorzata , Nicolini Laura Ambra , Toscanini Federica , Giacobbe Daniele Roberto , Vena Antonio , Taramasso Lucia , Balletto Elisa , Portunato Federica , Schenone Eva , Rosseti Nirmala , Baldi Federico , Berruti Marco , Briano Federica , Dettori Silvia , Labate Laura , Magnasco Laura , Mirabella Michele , Pincino Rachele , Russo Chiara , Sarteschi Giovanni , Sepulcri Chiara , Tutino Stefania , Pontremoli Roberto , Beccati Valentina , Casciaro Salvatore , Casu Massimo , Gavaudan Francesco , Ghinatti Maria , Gualco Elisa , Leoncini Giovanna , Pitto Paola , Salam Kassem , Gratarola Angelo , Bixio Mattia , Amelia Annalisa , Balestra Andrea , Ballarino Paola , Bardi Nicholas , Boccafogli Roberto , Fezza Francesca , Calzolari Elisa , Castelli Marta , Cenni Elisabetta , Cortese Paolo , Cuttone Giuseppe , Feltrin Sara , Giovinazzo Stefano , Giuntini Patrizia , Natale Letizia , Orsi Davide , Pastorino Matteo , Perazzo Tommaso , Pescetelli Fabio , Schenone Federico , Serra Maria Grazia , Sottano Marco , Tallone Roberto , Amelotti Massimo , Majabò Marie Jeanne , Merlini Massimo , Perazzo Federica , Ahamd Nidal , Barbera Paolo , Bovio Marta , Vacca Paola , Collidà Andrea , Cutuli Ombretta , Lomeo Agnese , Gentilucci Francesca Fezza Nicola , Hussein Nadia , Malvezzi Emanuele , Massobrio Laura , Motta Giula , Pastorino Laura , Pollicardo Nicoletta , Sartini Stefano , Virga Paola Vacca Valentina , Porto Italo , Bezante Giampaolo , Della Bona Roberta , La Malfa Giovanni , Valbusa Alberto , Gil Ad Vered , Barisione Emanuela , Bellotti Michele , Teresita Aloe’ , Blanco Alessandro , Grosso Marco , Piroddi Maria Grazia , Moscatelli Paolo , Ballarino Paola , Caiti Matteo , Cenni Elisabetta , Giuntini Patrizia , Magnani Ottavia , Sukkar Samir , Cogorno Ludovica , Gradaschi Raffaella , Guiddo Erica , Martino Eleonora , Pisciotta Livia , Cavaliere Bruno , Cristina Rossi , Francesca Farina , Garibotto Giacomo , Esposito Pasquale , Passalacqua Giovanni , Bagnasco Diego , Braido Fulvio , Riccio Annamaria , Tagliabue Elena , Gustavino Claudio , Ferraiolo Antonella , Giuffrida Salvatore , Rosso Nicola , Morando Alessandra , Papalia Riccardo , Passerini Donata , Tiberio Gabriella , Orengo Giovanni , Battaglini Alberto , Ruffoni Silvano , Caglieris Sergio , Giacomini Mauro , Mora Sara 
Published: October 2020

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.