Severe Acute Kidney Injury Increases Death Risk in COVID-19-Associated ARDS

Human kidney on scientific background
Stage 3 acute kidney injury in COVID-19 is significantly associated with a higher risk for 28-day mortality.

Severe acute kidney injury (AKI) occurs frequently among patients with coronavirus disease 2019 (COVID-19) and acute respiratory distress syndrome (ARDS), and it is associated with high short-term mortality, according to the results of a new study.

Stéphane Gaudry, MD, PhD, of Avicenne Hospital in Bobigny, France, and colleagues studied 302 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes COVID-19, admitted to an intensive care unit (ICU) at 4 university hospitals. Of these patients, 82 did not receive invasive mechanical ventilation, 6 had end-stage kidney disease prior to infection, and 3 had cardiac arrest before hospital admission. The remaining 211 patients met the Berlin definition of ARDS and received invasive mechanical ventilation.

Stage 3 AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria developed in 55 (26%) of these patients within 7 days after ICU admission, Dr Gaudry and colleagues reported in the American Journal of Respiratory and Critical Care Medicine. In the remaining 156 patients, KDIGO AKI stages 1 and 2 developed in 26 (17%) and 24 (15%) patients within 7 days following ICU admission.

Among the 55 patients with stage 3 AKI at 28 days after ICU admission, 31 (56%) died, 12 (22%) were still hospitalized in the ICU, and 12 (22%) were discharged alive from the ICU, Dr Gaudry’s team reported. For patients without stage 3 AKI, these figures were 38 (24%), 38 (24%), and 80 (51%), respectively. On multivariable analysis, stage 3 AKI was significantly associated with 3.5-fold increased odds of mortality at 28 days (P =.02).

The median time from ICU admission to development of stage 3 AKI was 3 days. Patients with stage 3 AKI were more likely to have chronic kidney disease, higher body mass index, and higher Sequential Organ Failure Assessment score. They also received higher positive end expiratory pressure and more frequently received nitric oxide therapy or vasopressor support. Within 7 days following ICU admission, 30 patients (54%) with AKI stage 3 required renal replacement therapy (RRT) during the ICU stay. Of them, 13 (43%) were alive and still RRT-dependent at day 28.

The researchers wrote, “[d]espite the inherent limitation of its retrospective design, our study has the noticeable strength to describe a very homogeneous population of patients with the same underlying disease receiving invasive mechanical ventilation.”


Chaïbi K, Dao M, Pham T, et al. Severe acute kidney injury in COVID-19 patients with acute respiratory distress syndrome. Published online August 31, 2020. Am J Respir Crit Care Med. doi:10.1164/rccm.202005-1524LE