COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

Mitra K Nadim; Lui G Forni; Ravindra L Mehta; Michael J Connor Jr; Kathleen D Liu; Marlies Ostermann; Thomas Rimmelé; Alexander Zarbock; Samira Bell; Azra Bihorac; Vincenzo Cantaluppi; Eric Hoste; Faeq Husain-Syed; Michael J Germain; Stuart L Goldstein; Shruti Gupta; Michael Joannidis; Kianoush Kashani; Jay L Koyner; Matthieu Legrand; Nuttha Lumlertgul; Sumit Mohan; Neesh Pannu; Zhiyong Peng; Xose L Perez-Fernandez; Peter Pickkers; John Prowle; Thiago Reis; Nattachai Srisawat; Ashita Tolwani; Anitha Vijayan; Gianluca Villa; Li Yang; Claudio Ronco; John A Kellum

doi:10.1038/s41581-020-00356-5

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

Nat Rev Nephrol. 2020 Dec;16(12):747-764. doi: 10.1038/s41581-020-00356-5. Epub 2020 Oct 15.

Authors

Mitra K Nadim¹, Lui G Forni^{2

3}, Ravindra L Mehta⁴, Michael J Connor Jr⁵, Kathleen D Liu⁶, Marlies Ostermann⁷, Thomas Rimmelé⁸, Alexander Zarbock⁹, Samira Bell¹⁰, Azra Bihorac¹¹, Vincenzo Cantaluppi¹², Eric Hoste¹³, Faeq Husain-Syed¹⁴, Michael J Germain¹⁵, Stuart L Goldstein¹⁶, Shruti Gupta¹⁷, Michael Joannidis¹⁸, Kianoush Kashani¹⁹, Jay L Koyner²⁰, Matthieu Legrand²¹, Nuttha Lumlertgul^{7

22}, Sumit Mohan^{23

24}, Neesh Pannu²⁵, Zhiyong Peng²⁶, Xose L Perez-Fernandez²⁷, Peter Pickkers²⁸, John Prowle²⁹, Thiago Reis^{30

31}, Nattachai Srisawat^{22

32}, Ashita Tolwani³³, Anitha Vijayan³⁴, Gianluca Villa³⁵, Li Yang³⁶, Claudio Ronco^{30

37}, John A Kellum³⁸

Affiliations

¹ Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
² Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK.
³ Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
⁴ Division of Nephrology, Department of Medicine, University of California, San Diego, CA, USA.
⁵ Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine, Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁶ Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, CA, USA.
⁷ Department of Intensive Care, Guy's & St Thomas' NHS Foundation Hospital, London, UK.
⁸ Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
⁹ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
¹⁰ Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
¹¹ Department of Medicine, University of Florida, Gainesville, FL, USA.
¹² Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
¹³ Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium.
¹⁴ Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Medicine II, University Hospital Giessen and Marburg, Giessen, Germany.
¹⁵ Division of Nephrology, Renal Transplant Associates of New England, Baystate Medical Center U Mass Medical School, Springfield, MA, USA.
¹⁶ Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹⁷ Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹⁸ Division of Intensive Care and Emergency Medicine, Department of Medicine, Medical University of Innsbruck, Innsbruck, Austria.
¹⁹ Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
²⁰ Division of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.
²¹ Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
²² Division of Nephrology, Excellence Center for Critical Care Nephrology, Critical Care Nephrology Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
²³ Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY, USA.
²⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
²⁵ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
²⁶ Division of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
²⁷ Servei de Medicina Intensiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
²⁸ Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands.
²⁹ Critical Care and Peri-operative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
³⁰ Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy.
³¹ Department of Nephrology, Clínica de Doenças Renais de Brasília, Brasília, Brazil.
³² Academy of Science, Royal Society of Thailand, Bangkok, Thailand.
³³ Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, AL, USA.
³⁴ Division of Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
³⁵ Section of Anaesthesiology and Intensive Care, Department of Health Science, University of Florence, Florence, Italy.
³⁶ Renal Division, Peking University First Hospital, Beijing, China.
³⁷ Department of Medicine, University of Padova, Padova, Italy.
³⁸ Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA. kellumja@upmc.edu.

Abstract

Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional 'surges' in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

Publication types

Consensus Development Conference
Research Support, Non-U.S. Gov't
Review

MeSH terms

Acute Kidney Injury / diagnosis
Acute Kidney Injury / pathology
Acute Kidney Injury / therapy*
Acute Kidney Injury / virology*
Anticoagulants / therapeutic use
COVID-19 / complications*
COVID-19 / therapy*
Consensus
Humans
Renal Replacement Therapy / methods*
Risk Factors
SARS-CoV-2

Substances

Anticoagulants