lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Caution on Kidney Dysfunctions of COVID-19 Patients

38 Pages Posted: 1 Apr 2020

See all articles by Zhen Li

Zhen Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

Ming Wu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

Jiwei Yao

Government of the People's Republic of China - State Key Laboratory of Trauma, Burns and Combined Injury

Jie Guo

Hubei Polytechnic University - Department of Gastrointestinal Endoscopy

Xiang Liao

Chongqing University - Center for Neurointelligence

Siji Song

Government of the People's Republic of China - Department of Urology

Jiali Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

Guangjie Duan

Government of the People's Republic of China - Department of Pathology

Yuanxiu Zhou

Government of the People's Republic of China - Department of Urology

Xiaojun Wu

Government of the People's Republic of China - Department of Urology

Zhansong Zhou

Government of the People's Republic of China - Department of Urology

Taojiao Wang

Hubei Polytechnic University - Department of Otolaryngology

Ming Hu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

Xianxiang Chen

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

Yu Fu

National University of Singapore (NUS) - Department of Physiology

Chong Lei

Government of the People's Republic of China - Department of Anesthesiology and Perioprative Medicine

Hailong Dong

Government of the People's Republic of China - Department of Anesthesiology and Perioprative Medicine

Chuou Xu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

Yahua Hu

Hubei Polytechnic University - Huangshi Central Hospital

Min Han

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Nephrology

Yi Zhou

Government of the People's Republic of China - Chongqing Key Laboratory of Neurobiology

Hongbo Jia

Technische Universität München (TUM) - Institute of Neuroscience

Xiaowei Chen

Government of the People's Republic of China - Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury

Junan Yan

Government of the People's Republic of China - Department of Urology

More...

Abstract

Background: To date, large amounts of epidemiological and case study data have been available for the Coronavirus Disease 2019 (COVID-19), which suggested that the mortality was related to not just respiratory complications. Here, we specifically analyzed kidney functions in COVID-19 patients and their relations to mortality.

Methods: In this multi-centered, retrospective, observational study, we included 193 adult patients with laboratory-confirmed COVID-19 from 2 hospitals in Wuhan, 1 hospital in Huangshi (Hubei province, 83 km from Wuhan) and 1 hospital in Chongqing (754 km from Wuhan). Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected, including data regarding to kidney functions. Data were compared among three groups: non-severe COVID-19 patients (128), severe COVID-19 patients (65) and a control group of other pneumonia (28). For the data from computed tomographic (CT) scans, we also included a control group of healthy subjects (110 cases, without abnormalities in the lung and without kidney diseases). The primary outcome was a common presence of kidney dysfunctions in COVID-19 patients and the occurrence of acute kidney injury (AKI) in a fraction of COVID-19 patients. Secondary outcomes included a survival analysis of COVID-19 patients in conditions of AKI or comorbid chronic illnesses.

Findings: We included 193 COVID-19 patients (128 non-severe, 65 severe (including 32 non-survivors), between January 6th and February 21st ,2020; the final date of follow-up was March 4th, 2020) and 28 patients of other pneumonia (15 of viral pneumonia, 13 of mycoplasma pneumonia) before the COVID-19 outbreak. On hospital admission, a remarkable fraction of patients had signs of kidney dysfunctions, including 59% with proteinuria, 44% with hematuria, 14% with increased levels of blood urea nitrogen, and 10% with increased levels of serum creatinine, although mild but worse than that in cases with other pneumonia. While these kidney dysfunctions might not be readily diagnosed as AKI at admission, over the progress during hospitalization they could be gradually worsened and diagnosed as AKI. A univariate Cox regression analysis showed that proteinuria, hematuria, and elevated levels of blood urea nitrogen, serum creatinine, uric acid as well as D-dimer were significantly associated with the death of COVID-19 patients respectively. Importantly, the Cox regression analysis also suggested that COVID-19 patients that developed AKI had a ~5.3-times mortality risk of those without AKI, much higher than that of comorbid chronic illnesses (~1.5 times risk of those without comorbid chronic illnesses).

Interpretation: To prevent fatality in such conditions, we suggested a high degree of caution in monitoring the kidney functions of severe COVID-19 patients regardless of the past disease history. In addition, upon day-by-day monitoring, clinicians should consider any potential interventions to protect kidney functions at the early stage of the disease and renal replacement therapies in severely ill patients, particularly for those with strong inflammatory reactions or a cytokine storm.

Funding Statement: This study was supported by grants from the “1000-Talents Program for Young Scholars” of China (X. Chen) and the “100-Talents Program for Elite Engineers” of the CAS (H. Jia). X. Chen is a junior fellow of the CAS Center for Excellence in Brain Science and Intelligence Technology.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This study has been approved by the Ethics Commissions of Wuhan Tongji Hospital (TJ-IRB20200216). Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases.

Suggested Citation

Li, Zhen and Wu, Ming and Yao, Jiwei and Guo, Jie and Liao, Xiang and Song, Siji and Li, Jiali and Duan, Guangjie and Zhou, Yuanxiu and Wu, Xiaojun and Zhou, Zhansong and Wang, Taojiao and Hu, Ming and Chen, Xianxiang and Fu, Yu and Lei, Chong and Dong, Hailong and Xu, Chuou and Hu, Yahua and Han, Min and Zhou, Yi and Jia, Hongbo and Chen, Xiaowei and Yan, Junan, Caution on Kidney Dysfunctions of COVID-19 Patients (3/19/2020). Available at SSRN: https://ssrn.com/abstract=3559601 or http://dx.doi.org/10.2139/ssrn.3559601

Zhen Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

No.1095 Jiefang Avenue
Wuhan, 430030
China

Ming Wu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

China

Jiwei Yao

Government of the People's Republic of China - State Key Laboratory of Trauma, Burns and Combined Injury

China

Jie Guo

Hubei Polytechnic University - Department of Gastrointestinal Endoscopy

Huangshi, 435000
China

Xiang Liao

Chongqing University - Center for Neurointelligence

Chongqing, 400030
China

Siji Song

Government of the People's Republic of China - Department of Urology

Chongqing, 400038
China

Jiali Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

No.1095 Jiefang Avenue
Wuhan, 430030
China

Guangjie Duan

Government of the People's Republic of China - Department of Pathology

Chongqing, 400038
China

Yuanxiu Zhou

Government of the People's Republic of China - Department of Urology

Chongqing, 400038
China

Xiaojun Wu

Government of the People's Republic of China - Department of Urology

Chongqing, 400038
China

Zhansong Zhou

Government of the People's Republic of China - Department of Urology

Chongqing, 400038
China

Taojiao Wang

Hubei Polytechnic University - Department of Otolaryngology

Huangshi, 435000
China

Ming Hu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

China

Xianxiang Chen

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

China

Yu Fu

National University of Singapore (NUS) - Department of Physiology

Singapore, 117597
China

Chong Lei

Government of the People's Republic of China - Department of Anesthesiology and Perioprative Medicine

Xi’an, 710032
China

Hailong Dong

Government of the People's Republic of China - Department of Anesthesiology and Perioprative Medicine

Xi’an, 710032
China

Chuou Xu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

No.1095 Jiefang Avenue
Wuhan, 430030
China

Yahua Hu

Hubei Polytechnic University - Huangshi Central Hospital

Hubei
China

Min Han

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Nephrology ( email )

China

Yi Zhou

Government of the People's Republic of China - Chongqing Key Laboratory of Neurobiology ( email )

Chongqing, 400038
China

Hongbo Jia

Technische Universität München (TUM) - Institute of Neuroscience ( email )

Munich, 81675
Germany

Xiaowei Chen

Government of the People's Republic of China - Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury ( email )

Chongqing, 400038
China

Junan Yan (Contact Author)

Government of the People's Republic of China - Department of Urology ( email )

Chongqing, 400038
China

Click here to go to TheLancet.com

Paper statistics

Abstract Views
3,098
Downloads
705
PlumX Metrics