Association of AKI-D with Urinary Findings and Baseline eGFR in Hospitalized COVID-19 Patients

Background: Acute kidney injury (AKI) is common in patients hospitalized with coronavirus disease 2019 (COVID-19). Risk factors for AKI requiring dialysis (AKI-D) are not fully understood. We aimed to identify risk factors associated with AKI-D and AKI not requiring dialysis (AKI-ND). Methods: We reviewed electronic health records of 3186 patients aged > 18 years old hospitalized with COVID-19 across six hospitals. Patient characteristics, urinalysis findings, and inflammatory markers were analyzed for association with in-hospital AKI status (AKI-D, AKI-ND, or no AKI), and we subsequently evaluated mortality. Results: After adjustment for multiple covariates, higher baseline eGFR was associated with 30% lower odds of AKI-D and 11% lower odds of AKI-ND (OR 0.70, 95% CI 0.64-0.77 for AKI-D; OR 0.89, 95% CI 0.85-0.92 for AKI-ND). Patients with obesity and Latino patients had increased odds of AKI-D, whereas those with congestive heart failure or diabetes with complications had increased odds of AKI-ND. Females had lower odds of in-hospital AKI (OR 0.28, 95% CI 0.17-0.46 for AKI-D; OR 0.83, 95% CI 0.70-0.99 for AKI-ND). After adjustment for covariates and baseline eGFR, 1-4+ protein on initial urinalysis was associated with a 9-fold increase in odds of AKI-D (OR 9.00, 95% CI 2.16-37.38) and > 2-fold higher odds of AKI-ND (OR 2.28, 95% CI 1.66-3.13). 1-3+ blood and trace glucose on initial urinalysis were also associated with increased odds of both AKI-D and AKI-ND. AKI-D and AKI-ND were associated with in-hospital death (OR 2.64, 95% CI 1.13-6.17 for AKI-D; OR 2.44, 95% CI 1.77-3.35 for AKI-ND). Conclusions: Active urine sediments, even after adjustment for baseline kidney function, and reduced baseline eGFR are significantly associated with increased odds of AKI-D and AKI-ND. In-hospital AKI was associated with in-hospital death. These findings may help prognosticate patients hospitalized with COVID-19.