Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection
Background This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. Methods In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, C...
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Taylor & Francis Group
2021-01-01
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Series: | Renal Failure |
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Online Access: | http://dx.doi.org/10.1080/0886022X.2021.1979039 |
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English |
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DOAJ |
author |
Zijin Chen Chenni Gao Haijin Yu Lin Lu Jialin Liu Wei Chen Xiaogang Xiang Hafiz Muhammad Jafar Hussain Benjamin J. Lee Chuanlei Li Wenjie Wei Yuhan Huang Xiang Li Zhengying Fang Shuwen Yu Qinjie Weng Yan Ouyang Xiaofan Hu Jun Tong Jian Liu Li Lin Mingyu Liu Xiaoman Xu Dan Liu Yuan Song Xifeng Lv Yixin Zha Zhiyin Ye Tingting Jiang Jieshuang Jia Xiaonong Chen Yufang Bi Jun Xue Nan Chen Weiguo Hu Cijiang John He Huiming Wang Jun Liu Jingyuan Xie |
spellingShingle |
Zijin Chen Chenni Gao Haijin Yu Lin Lu Jialin Liu Wei Chen Xiaogang Xiang Hafiz Muhammad Jafar Hussain Benjamin J. Lee Chuanlei Li Wenjie Wei Yuhan Huang Xiang Li Zhengying Fang Shuwen Yu Qinjie Weng Yan Ouyang Xiaofan Hu Jun Tong Jian Liu Li Lin Mingyu Liu Xiaoman Xu Dan Liu Yuan Song Xifeng Lv Yixin Zha Zhiyin Ye Tingting Jiang Jieshuang Jia Xiaonong Chen Yufang Bi Jun Xue Nan Chen Weiguo Hu Cijiang John He Huiming Wang Jun Liu Jingyuan Xie Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection Renal Failure covid-19 proximal tubule acute kidney injury risk factors hypophosphate |
author_facet |
Zijin Chen Chenni Gao Haijin Yu Lin Lu Jialin Liu Wei Chen Xiaogang Xiang Hafiz Muhammad Jafar Hussain Benjamin J. Lee Chuanlei Li Wenjie Wei Yuhan Huang Xiang Li Zhengying Fang Shuwen Yu Qinjie Weng Yan Ouyang Xiaofan Hu Jun Tong Jian Liu Li Lin Mingyu Liu Xiaoman Xu Dan Liu Yuan Song Xifeng Lv Yixin Zha Zhiyin Ye Tingting Jiang Jieshuang Jia Xiaonong Chen Yufang Bi Jun Xue Nan Chen Weiguo Hu Cijiang John He Huiming Wang Jun Liu Jingyuan Xie |
author_sort |
Zijin Chen |
title |
Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection |
title_short |
Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection |
title_full |
Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection |
title_fullStr |
Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection |
title_full_unstemmed |
Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection |
title_sort |
hypophosphatemia is an independent risk factor for aki among hospitalized patients with covid-19 infection |
publisher |
Taylor & Francis Group |
series |
Renal Failure |
issn |
0886-022X 1525-6049 |
publishDate |
2021-01-01 |
description |
Background This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. Methods In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, China between February 2020 and April 2020. Clinical and laboratory parameters at the time of admission and follow-up data were recorded. Systemic renal tubular dysfunction was evaluated via 24-h urine collections in a subgroup of 55 patients. Results In total, 823 patients were enrolled (50.5% male) with a mean age of 60.9 ± 14.9 years. AKI occurred in 38 (40.9%) ICU cases but only 6 (0.8%) non-ICU cases. Using forward stepwise Cox regression analysis, we found eight independent risk factors for AKI including decreased platelet level, lower albumin level, lower phosphorus level, higher level of lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), urea, and prothrombin time (PT) on admission. For every 0.1 mmol/L decreases in serum phosphorus level, patients had a 1.34-fold (95% CI 1.14–1.58) increased risk of AKI. Patients with hypophosphatemia were likely to be older and with lower lymphocyte count, lower serum albumin level, lower uric acid, higher LDH, and higher CRP. Furthermore, serum phosphorus level was positively correlated with phosphate tubular maximum per volume of filtrate (TmP/GFR) (Pearson r = 0.66, p < .001) in subgroup analysis, indicating renal phosphate loss via proximal renal tubular dysfunction. Conclusion The AKI incidence was very low in non-ICU patients as compared to ICU patients. Hypophosphatemia is an independent risk factor for AKI in patients hospitalized for COVID-19 infection. |
topic |
covid-19 proximal tubule acute kidney injury risk factors hypophosphate |
url |
http://dx.doi.org/10.1080/0886022X.2021.1979039 |
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doaj-4038679867c644bba193d816ecd0f2042021-09-24T14:41:21ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492021-01-014311329133710.1080/0886022X.2021.19790391979039Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infectionZijin Chen0Chenni Gao1Haijin Yu2Lin Lu3Jialin Liu4Wei Chen5Xiaogang Xiang6Hafiz Muhammad Jafar Hussain7Benjamin J. Lee8Chuanlei Li9Wenjie Wei10Yuhan Huang11Xiang Li12Zhengying Fang13Shuwen Yu14Qinjie Weng15Yan Ouyang16Xiaofan Hu17Jun Tong18Jian Liu19Li Lin20Mingyu Liu21Xiaoman Xu22Dan Liu23Yuan Song24Xifeng Lv25Yixin Zha26Zhiyin Ye27Tingting Jiang28Jieshuang Jia29Xiaonong Chen30Yufang Bi31Jun Xue32Nan Chen33Weiguo Hu34Cijiang John He35Huiming Wang36Jun Liu37Jingyuan Xie38Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, North Huashan Hospital, Fudan UniversityDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University, School of medicineDepartment of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University, School of MedicineDepartment of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineHouston Kidney ConsultantsDepartment of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineWuhan Ninth HospitalRenal Department, Wuhan Ninth HospitalRadiology Department of Renmin Hospital, Wuhan UniversityRenal Department of Renmin Hospital, Renmin Hospital of Wuhan UniversityRenal Department of Renmin Hospital, Renmin Hospital of Wuhan UniversityClinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Endocrinology and Metabolism disease, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Nephrology, Huashan Hospital, Fudan UniversityDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineDepartment of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDivision of Nephrology, Mount Sinai School of MedicineRenal Department of Renmin Hospital, Renmin Hospital of Wuhan UniversityDepartment of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of MedicineBackground This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. Methods In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, China between February 2020 and April 2020. Clinical and laboratory parameters at the time of admission and follow-up data were recorded. Systemic renal tubular dysfunction was evaluated via 24-h urine collections in a subgroup of 55 patients. Results In total, 823 patients were enrolled (50.5% male) with a mean age of 60.9 ± 14.9 years. AKI occurred in 38 (40.9%) ICU cases but only 6 (0.8%) non-ICU cases. Using forward stepwise Cox regression analysis, we found eight independent risk factors for AKI including decreased platelet level, lower albumin level, lower phosphorus level, higher level of lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), urea, and prothrombin time (PT) on admission. For every 0.1 mmol/L decreases in serum phosphorus level, patients had a 1.34-fold (95% CI 1.14–1.58) increased risk of AKI. Patients with hypophosphatemia were likely to be older and with lower lymphocyte count, lower serum albumin level, lower uric acid, higher LDH, and higher CRP. Furthermore, serum phosphorus level was positively correlated with phosphate tubular maximum per volume of filtrate (TmP/GFR) (Pearson r = 0.66, p < .001) in subgroup analysis, indicating renal phosphate loss via proximal renal tubular dysfunction. Conclusion The AKI incidence was very low in non-ICU patients as compared to ICU patients. Hypophosphatemia is an independent risk factor for AKI in patients hospitalized for COVID-19 infection.http://dx.doi.org/10.1080/0886022X.2021.1979039covid-19proximal tubuleacute kidney injuryrisk factorshypophosphate |