COVID-19 patients with Acute Kidney Injury more likely to experience severe illness, Manchester research finds

COVID-19 patients with Acute Kidney Injury (AKI) – a complication where the organ suddenly stops working properly – are more likely to experience severe illness or even die compared to those without AKI, research has found.

AKI normally happens as a complication of another serious illness and is most often seen in older people. The condition – which was identified as a prominent feature in COVID-19 early in the pandemic – can range from minor loss of kidney function to complete organ failure. If not detected and treated quickly, salts and other chemicals can build up in the body and prevent other organs from working properly, leading to critical illness and even death.

Photo of 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, Mr Prasanna Hanumapura - AKI Clinical Nurse Specialist Lead, Dr Rachael Challiner - Consultant in Nephrology and Intensive Care Medicine, Dr Leonard Ebah - Deputy Medical Director & Consultant Nephrologist, Mrs Katherine Parker - Specialist Renal Pharmacist.

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.

Manchester University NHS Foundation Trust (MFT) researchers have shed further light on the association between AKI and COVID-19. Their findings, published in PLOS Medicine, show that of the 1,032 COVID-19 patients studied, the 210 (20 per cent) diagnosed with AKI suffered worse outcomes than those without, including:

  • AKI patients were three times more likely to need intensive care, with 34 per cent of AKI patients admitted to ICU, compared to 22 per cent in non-AKI
  • once in ICU, AKI patients were more likely (86 per cent) to require mechanical ventilation than non-AKI patients (25 per cent), and;
  • were more than twice (52 per cent) as likely to die than non-AKI patients (22 per cent).

The retrospective study looked at admissions and clinical data for COVID-19 patients admitted to MFT hospitals – including the Manchester Royal Infirmary (MRI), Wythenshawe Hospital, Trafford General Hospital, and Saint Mary’s Hospital – between 10 March and 30 April 2020. This included patients on both general wards and in intensive care.

Dr Leonard Ebah, Deputy Medical Director and Renal Consultant at the 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 patients COVID-19 patients with AKI are more likely to experience severe illness or even die.

“Our AKI team 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.”

Since 2015, MFT has successfully implemented a number of measures to reduce AKI incidence across its 10 hospitals. The number of patients admitted to MFT hospitals with AKI fell from 10 per cent (2015) to six per cent by 2019.

The Acute Kidney Injury team was formed in 2015 under the leadership of Dr Ebah, with the aim of reducing the overall impact of AKI on patients admitted to MFT hospitals. The multidisciplinary team consists of AKI Clinical Nurse specialists, nephrologists, intensivists and acute physicians, with nurse specialists providing a seven-day service across six of MFT’s hospitals. The team now ensure that 100 per cent of AKI patients are diagnosed within 24 hours.

The team have also shared their work on the national Think Kidneys website, which raises awareness and shares best practice of AKI.

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.”