MO406ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN HOSPITALIZED PATIENTS: A CROSS SECTIONAL STUDY FROM IRAN
Authors: Rostami Zohreh , Shafei Sepehr , Nemati Eghlim , Einollahi Behzad , Rostami Afsaneh 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury is an important finding in COVID-19 patients that can even result in renal replacement therapy. AKI complicates COVID-19 management by making volume management and administering agents with renal clearance challenging tasks. Various reasons have been proposed for the development of acute kidney injury in COVID-19 patients, including multi-organ failure and pre-renal causes, drug toxicity, tubular injury, and invasion of proximal tube podocytes by SARS-CoV-2. Although the development of AKI is not uncommon in COVID-19 patients, several inconsistencies in the literature exist regarding incidence rate and risk factors of acute kidney injury among hospitalized patients. This can be attributed to ethnical variations and methodological differences of studies. Herein we report AKI incidence in hospitalized COVID-19 patients in Baqiyatallah Hospital in Iran and investigate associate factors that can lead to AKI and renal replacement therapy in COVID-19 patients.

Method
In this cross-sectional study, we investigated medical records and laboratory data of hospitalized COVID-19 patients in Baqiyatallah Hospital in Tehran, Iran, from September 2020 until the end of November. COVID-19 infection was confirmed using polymerase chain reaction (PCR), and only patients with Positive PCR for COVID-19 were included. Furthermore, patients with missing data and unknown past medical history were excluded from this study, and a total of 459 patients were selected. The KDIGO criteria for acute kidney injury were used for evaluating kidney injury in COVID-19 patients. ICU admission and dialysis were according to the Ministry of Health and Medical Education on ICU admission and renal replacement therapy in COVID-19 patients.

Results
Of 459 patients with the criteria who were admitted to the hospital (244 male, 213 female, with an average age of 59.57 with SD 14.3), 75 patients (16%) developed acute kidney injury in the course of the disease. The mortality rate in patients with AKI (44%) was significantly higher than other patients (9%). The development of the AKI was significantly associated with the risk of ICU admission and the severe forms of the disease. Furthermore, it was observed that the patients who developed AKI was significantly older and male gender, diabetes (DM), Hypertension (HTN), and Previous history of Chronic kidney disease(CKD) was also significantly associated with developing AKI in COVID-19 patients. Chronic heart failure and ischemic heart disease increased the odds of developing AKI, but it was not significant enough to come up with a conclusion. It was observed that from 75 patients who developed AKI, 22 patients (29%) required renal replacement therapy. Of 22 patients who need dialysis, 14 patients did not survive (mortality rate=63%). The previous history of kidney disease increases the risk of dialysis due to AKI, while no significant association was found between age, gender, DM, HTN, and heart disease with the need for dialysis.

Conclusion
Results of our study indicate that acute kidney injury can be a major obstacle in managing COVID-19 patients. Patients with older age, previous history of CKD, HTN, and DM should be admitted to the hospital and monitored closely to prevent unfortunate outcomes of this disease.