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Clinical Research
Open Access

AKI in Hospitalized Patients with COVID-19

Lili Chan, Kumardeep Chaudhary, Aparna Saha, Kinsuk Chauhan, Akhil Vaid, Shan Zhao, Ishan Paranjpe, Sulaiman Somani, Felix Richter, Riccardo Miotto, Anuradha Lala, Arash Kia, Prem Timsina, Li Li, Robert Freeman, Rong Chen, Jagat Narula, Allan C. Just, Carol Horowitz, Zahi Fayad, Carlos Cordon-Cardo, Eric Schadt, Matthew A. Levin, David L. Reich, Valentin Fuster, Barbara Murphy, John C. He, Alexander W. Charney, Erwin P. Böttinger, Benjamin S. Glicksberg, Steven G. Coca, Girish N. Nadkarni and on behalf of the Mount Sinai COVID Informatics Center (MSCIC)*
JASN January 2021, 32 (1) 151-160; DOI: https://doi.org/10.1681/ASN.2020050615
Lili Chan
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
3The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
4BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Kumardeep Chaudhary
3The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
4BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
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Aparna Saha
3The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
4BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Kinsuk Chauhan
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Akhil Vaid
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Shan Zhao
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
7Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Ishan Paranjpe
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Sulaiman Somani
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Felix Richter
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Riccardo Miotto
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Anuradha Lala
7Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
8The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Arash Kia
9Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
10Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Prem Timsina
9Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
10Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Li Li
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
11Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York
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Robert Freeman
9Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
10Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Rong Chen
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
11Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York
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Jagat Narula
12Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
13Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Allan C. Just
14Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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Carol Horowitz
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
9Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Zahi Fayad
15BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
16Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Carlos Cordon-Cardo
17Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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Eric Schadt
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
11Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York
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Matthew A. Levin
7Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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David L. Reich
7Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Valentin Fuster
8The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Barbara Murphy
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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John C. He
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Alexander W. Charney
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
18The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
19Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Erwin P. Böttinger
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
20Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
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Benjamin S. Glicksberg
5Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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Steven G. Coca
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Girish N. Nadkarni
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
3The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
4BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York
6The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
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    Figure 1.

    AKI requiring dialysis was common and varied by need for ICU admimssion. While 19% of patients overall required dialysis, 32% of patients who were admitted to the ICU required dialysis.

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    Figure 2.

    Approximately a third of patients did not have renal recovery at discharge or post-hospitalization follow up. Proportion of patients with AKI stratified by recovery versus nonrecovery at discharge and discharge follow-up. Recovery of kidney function was stratified into recover and AKD defined as (1) recovery: difference in creatinine is ≤0.3 and creatinine change in percentage is ≤25%; (2) stage 1: difference in creatinine is >0.3 and creatinine change in percentage is ≤25% or creatinine change in percentage is >25% and ≤100%; (3) stage 2: creatinine change in percentage is >100% and ≤200%; and (4) stage 3: creatinine change in percentage is >200% or requiring dialysis 72 hours prior to discharge.

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    Figure 3.

    Trajectory of creatinine during the first 14 days of hospitalizations in patients who were discharged by recovery and nonrecovery which demonstrate the severity and prolonged nature of the AKI. We used local regression (loess) for smoothening creatinine values across the interval of 2 weeks posthospital admission to visualize trajectories by AKD category.

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    Figure 4.

    Survival probability is lower in patients with AKI. Kaplan–Meier survival curves for patients with and without AKI. Red line indicates patients with AKI, and blue line is for those without AKI. All patients were censored at 30 days. Patients who were discharged alive before 30 days were treated as still at risk and not censored at discharge.

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    Table 1.

    Patient characteristics of all patients and those with and without AKI

    Patient CharacteristicsAll, n=3993AKI, n=1835No AKI, n=2158P Value
    Age, yr, median (IQR)64 (56–78)71 (61–81)63 (51–75)<0.001
    Sex, n (%)
     Women1704 (43)734 (40)970 (45)0.002
    Race/ethnicity, n (%)0.002
     White954 (24)439 (24)515 (24)
     Black1054 (36)536 (29)518 (24)
     Hispanic1038 (26)439 (24)599 (28)
     Asian173 (4)74 (4)99 (5)
     Other or unknown774 (19)347 (19)427 (20)
    Comorbidities, n (%)
     Hypertension1527 (38)820 (45)707 (33)<0.001
     Congestive heart failure396 (10)244 (13)152 (7)<0.001
     Diabetes mellitus1019 (26)568 (31)451 (21)<0.001
     Liver disease191 (5)99 (5)92 (4)0.09
     Peripheral vascular disease362 (9)194 (11)168 (8)0.002
     CKD420 (11)339 (18)81 (4)<0.001
    Laboratory values, median (IQR)
     White blood cell count, 103/μl7.55 (5.4–10.9)8.68 (6–12.3)6.9 (5.1–9.55)<0.001
     Lymphocyte percentage, %13.1 (8.1–20.6)10.6 (6–12.3)15.5 (9.8–23.1)<0.001
     Hemoglobin, g/dl12.6 (11.1–13.8)12.3 (10.7–13.8)12.8 (11.5–13.9)<0.001
     Platelets, 103/L214 (160–282)207 (151–272)221 (165–291)<0.001
     Sodium, mEq/L139 (136–142)139 (136–143)138 (136–141)<0.001
     Potassium, mEq/L4.2 (3.9–4.6)4.3 (3.9–4.8)4.1 (3.8–4.5)<0.001
     Chloride, mEq/L104 (101–107)104 (100–109)103 (101–106)<0.001
     Bicarbonate, mEq/L23 (20.5–26)22 (19–25)24 (21.8–26.1)<0.001
     BUN, mg/dl18 (12–32)31 (18–51)13 (10–19)<0.001
     Serum creatinine, mg/dl0.94 (0.72–1.41)1.42 (0.95–2.25)0.8 (0.67–0.97)<0.001
     AST, U/L42 (28–68)48 (30–79)39 (27–60)<0.001
     ALT, U/L30 (18–52)29 (18–53)30 (19–52)<0.001
     Alkaline phosphatase, U/L75 (59–100)76 (60–102)73 (58–98)0.005
     Albumin, g/dl2.9 (2.6–3.3)2.8 (2.5–3.2)3 (2.7–3.4)<0.001
    Vital signs, median (IQR)
     Temperature, °C36.9 (36.6–37.5)36.9 (36.5–37.4)37(36.6–37.5)<0.001
     Systolic BP, mm Hg124 (111–140)125 (111–141.5)124 (112–138)0.40
     Diastolic BP, mm Hg71 (63–79)70 (61–80)72 (64–79)<0.001
     Heart rate, BPM87 (76–98)87 (76–99)87 (76–97)0.08
     Respiratory rate, per min19 (10–20)20 (18–21)18 (18–20)<0.001
     Oxygen saturation, %96 (94–98)96 (94–98)96 (95–98)<0.001
    Discharged, n (%)3869 (97)1750 (95)2119 (98)<0.001
    Hospital facility<0.001
     Mount Sinai Hospital located in East Harlem, Manhattan1507 (38)662 (36)845 (39)
     Mount Sinai Morningside located in Morningside Heights, Manhattan699 (18)340 (19)359 (17)
     Mount Sinai West located in Midtown and the West Side, Manhattan480 (12)167 (9)313 (15)
     Mount Sinai Brooklyn located in Midwood, Brooklyn641 (16)345 (19)296 (14)
     Mount Sinai Queens located in Astoria, Queens666 (17)321 (18)345 (16)
    • AST, aspartate transaminase; ALT, alanine transaminase; BPM, beats per minute.

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Journal of the American Society of Nephrology: 32 (1)
Journal of the American Society of Nephrology
Vol. 32, Issue 1
January 2021
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AKI in Hospitalized Patients with COVID-19
Lili Chan, Kumardeep Chaudhary, Aparna Saha, Kinsuk Chauhan, Akhil Vaid, Shan Zhao, Ishan Paranjpe, Sulaiman Somani, Felix Richter, Riccardo Miotto, Anuradha Lala, Arash Kia, Prem Timsina, Li Li, Robert Freeman, Rong Chen, Jagat Narula, Allan C. Just, Carol Horowitz, Zahi Fayad, Carlos Cordon-Cardo, Eric Schadt, Matthew A. Levin, David L. Reich, Valentin Fuster, Barbara Murphy, John C. He, Alexander W. Charney, Erwin P. Böttinger, Benjamin S. Glicksberg, Steven G. Coca, Girish N. Nadkarni, on behalf of the Mount Sinai COVID Informatics Center (MSCIC)*
JASN Jan 2021, 32 (1) 151-160; DOI: 10.1681/ASN.2020050615

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AKI in Hospitalized Patients with COVID-19
Lili Chan, Kumardeep Chaudhary, Aparna Saha, Kinsuk Chauhan, Akhil Vaid, Shan Zhao, Ishan Paranjpe, Sulaiman Somani, Felix Richter, Riccardo Miotto, Anuradha Lala, Arash Kia, Prem Timsina, Li Li, Robert Freeman, Rong Chen, Jagat Narula, Allan C. Just, Carol Horowitz, Zahi Fayad, Carlos Cordon-Cardo, Eric Schadt, Matthew A. Levin, David L. Reich, Valentin Fuster, Barbara Murphy, John C. He, Alexander W. Charney, Erwin P. Böttinger, Benjamin S. Glicksberg, Steven G. Coca, Girish N. Nadkarni, on behalf of the Mount Sinai COVID Informatics Center (MSCIC)*
JASN Jan 2021, 32 (1) 151-160; DOI: 10.1681/ASN.2020050615
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