Acute Kidney Injury and COVID-19: A research study
Manchester University NHS Foundation Trust
As the first wave of the COVID-19 pandemic spread throughout Europe during the spring of 2020, initial reports focussed on the respiratory manifestations of the disease. As more data emerged from other countries, such as China and the US, it became increasingly apparent that kidney damage (Acute Kidney Injury, or AKI) was a prominent feature of the virus and may have a bearing on patient outcomes.
Understanding the epidemiology and features of kidney damage in COVID-19 was an essential first step to improving management and preventing future cases.
Between March and May 2020, Manchester Foundation Trust (MFT) staff carried out the study ‘Characteristics and outcomes of hospitalised patients with acute kidney injury and COVID-19.’ The study looked at admissions and clinical data for 1,032 COVID-19 patients admitted to MFT hospitals between 10 March and 30 April 2020. Of these, 210 (20 per cent) had a diagnosis of AKI.
This was one of the largest European studies of AKI in COVID-19, involving patients both on general wards and intensive care across MFT hospitals, including the Manchester Royal Infirmary (MRI), Wythenshawe Hospital, Trafford General Hospital, and Saint Mary’s Hospital. It found:
- One in five (210) hospitalised patients with COVID-19 had AKI
- Those with AKI were twice as likely to die than those without AKI
- AKI seemed to be a marker of more severe illness from COVID-19, with one in three of these patients requiring intensive care, compared to just one in 10 for those without AKI
- Black, male, and those with diabetic complications were more likely to develop AKI
- Of patients who had AKI and survived, the majority (82%) recovered kidney function, while only two remained on dialysis.
MFT has significant experience in improving care and outcomes for AKI patients. Since 2015, the Trust has successfully implemented a number of measures to reduce incidence of AKI across all hospitals sites, including highly-experienced multidisciplinary teams and a multi-faceted quality improvement programme. By 2019, AKI incidence had reduced from 10 per cent of patients admitted to hospital, to six per cent. While a worldwide lack of understanding on this new disease and its complications posed a significant challenge during the first wave, this previous work meant MFT staff were well-placed to respond to AKI complications and quickly launch vital research studies. Nurse specialists provide a seven-day service across six MFT hospitals, and the team ensure that 100 per cent of AKI patients are diagnosed within 24 hours.
Dr Leonard Ebah, Deputy Medical Director and Renal Consultant at the Trust’s Manchester Royal Infirmary (MRI), and lead author of the research paper, said:
“Much of the focus around COVID-19 has been on its effects on the lungs and respiratory system. However, research by Chinese and US colleagues early in the pandemic identified kidney damage as another prominent feature of the virus that could have a potential impact on patient outcomes. There is still a worldwide lack of understanding of the relationship between COVID-19 and AKI. Our study was one of the largest studies of COVID and AKI patients in Europe and adds weight to earlier research that COVID-19 patients with AKI are more likely to experience severe illness or even die.
Our AKI team Led by Prasanna Hanumapura at MFT have a huge amount of experience in reducing AKI incidence across our hospitals. We’re proud to shed more light on the link between COVID-19 and AKI and hope further research can help clinicians better manage AKI complications, improve care and outcomes for these patients.”
Dr Rachael Challiner, Consultant in Nephrology and Intensive Care at the MRI, added:
“Our better understanding of the incidence and impact of kidney injury in COVID-19 patients has informed our management strategies here at MFT and we are already seeing fewer cases of AKI even in the most critically unwell patients within the Trust. The AKI team at MFT hope the findings from this study and those from other groups will help health policy makers and frontline staff to develop proactive strategies to preserve kidney function and diagnose and manage AKI early in patients with COVID-19. This would hopefully lead to better patient outcomes in both the current and future waves of COVID-19.”
MFT AKI research team (L-R): Dr Patrick Hamilton – Specialist Registrar in Nephrology, Dr Robert Henney – Consultant Acute Physician & Nephrologist, Laveena Castelino – AKI Clinical Nurse Specialist, Prasanna Hanumapura – AKI Clinical Nurse Specialist Lead, Dr Rachael Challiner – Consultant in Nephrology and Intensive Care Medicine, Dr Leonard Ebah – Consultant Nephrologist, Katherine Parker – Specialist Renal Pharmacist.
