Acute Kidney Injury Seen in Most Severe COVID-19 Cases- BMJ
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New data from two health systems in New York City -- where hospitals struggled to keep up with dialysis demands as they were flooded with COVID-19 patients -- detailed a high rate of acute kidney injury among infected patients.

In the first 1,000 patients with COVID-19 at NewYork-Irving Medical Center, 33.9% developed acute kidney injury.

Of the 236 who ended up in the ICU, 78% developed AKI. A separate analysis of nearly 5,500 patients with COVID-19 treated by April 5 in the 13 hospitals of the Northwell Health system, the AKI rate was a similar 36.6%.

The rate was 89.7% among those on mechanical ventilation. New York City hospitals had described precarious situations with dialysis supply and machine shortages, with at least one death reportedly due to lack of capacity to cope with the surge of acute kidney injury during the peak of COVID-19 cases in the city.

While about half of patients only reached stage 1 AKI, stage 2 developed in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy, and 96.8% of the 285 who did need dialysis were on ventilators.

Prognosis of those who developed AKI was poor as 35% died. It was "bleaker" with requirement for dialysis: 157 of the 285 such patients died and "only 9 were discharged from the hospital at the time of analysis."

The high rate of renal complications might have been in part due to limiting use of IV fluids when treating patients with acute respiratory distress syndrome as a lung protective fluid management strategy, researchers noted.

Source: https://www.bmj.com/content/369/bmj.m1996
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