Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection

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

doi:10.1080/0886022X.2021.1979039

Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection

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 LiuLi 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

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English (US)
Pages (from-to)	1329-1337
Number of pages	9
Journal	Renal Failure
Volume	43
Issue number	1
DOIs	https://doi.org/10.1080/0886022X.2021.1979039
State	Published - Dec 2021

Keywords

Acute Kidney Injury/epidemiology
COVID-19/complications
China/epidemiology
Female
Hospitalization
Humans
Hypophosphatemia/complications
Incidence
Intensive Care Units
Kidney Function Tests
Male
Middle Aged
Pneumonia, Viral/complications
Retrospective Studies
Risk Factors
SARS-CoV-2

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10.1080/0886022X.2021.1979039

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Chen, Z., Gao, C., Yu, H., Lu, L., Liu, J., Chen, W., Xiang, X., Hussain, H. M. J., Lee, B. J., Li, C., Wei, W., Huang, Y., Li, X., Fang, Z., Yu, S., Weng, Q., Ouyang, Y., Hu, X., Tong, J., ... Xie, J. (2021). Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection. Renal Failure, 43(1), 1329-1337. https://doi.org/10.1080/0886022X.2021.1979039

Chen, Z, Gao, C, Yu, H, Lu, L, Liu, J, Chen, W, Xiang, X, Hussain, HMJ, Lee, BJ, Li, C, Wei, W, Huang, Y, Li, X, Fang, Z, Yu, S, Weng, Q, Ouyang, Y, Hu, X, Tong, J, Liu, J, Lin, L, Liu, M, Xu, X, Liu, D, Song, Y, Lv, X, Zha, Y, Ye, Z, Jiang, T, Jia, J, Chen, X, Bi, Y, Xue, J, Chen, N, Hu, W, He, CJ, Wang, H, Liu, J & Xie, J 2021, 'Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection', Renal Failure, vol. 43, no. 1, pp. 1329-1337. https://doi.org/10.1080/0886022X.2021.1979039

@article{aab0b7af05b6406dae7a2a6d29ccf2aa,

title = "Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection",

abstract = "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.",

keywords = "Acute Kidney Injury/epidemiology, COVID-19/complications, China/epidemiology, Female, Hospitalization, Humans, Hypophosphatemia/complications, Incidence, Intensive Care Units, Kidney Function Tests, Male, Middle Aged, Pneumonia, Viral/complications, Retrospective Studies, Risk Factors, SARS-CoV-2",

author = "Zijin Chen and Chenni Gao and Haijin Yu and Lin Lu and Jialin Liu and Wei Chen and Xiaogang Xiang and Hussain, {Hafiz Muhammad Jafar} and Lee, {Benjamin J} and Chuanlei Li and Wenjie Wei and Yuhan Huang and Xiang Li and Zhengying Fang and Shuwen Yu and Qinjie Weng and Yan Ouyang and Xiaofan Hu and Jun Tong and Jian Liu and Li Lin and Mingyu Liu and Xiaoman Xu and Dan Liu and Yuan Song and Xifeng Lv and Yixin Zha and Zhiyin Ye and Tingting Jiang and Jieshuang Jia and Xiaonong Chen and Yufang Bi and Jun Xue and Nan Chen and Weiguo Hu and He, {Cijiang John} and Huiming Wang and Jun Liu and Jingyuan Xie",

year = "2021",

month = dec,

doi = "10.1080/0886022X.2021.1979039",

language = "English (US)",

volume = "43",

pages = "1329--1337",

journal = "Renal Failure",

issn = "0886-022X",

publisher = "Informa Healthcare",

number = "1",

}

TY - JOUR

T1 - Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection

AU - Chen, Zijin

AU - Gao, Chenni

AU - Yu, Haijin

AU - Lu, Lin

AU - Liu, Jialin

AU - Chen, Wei

AU - Xiang, Xiaogang

AU - Hussain, Hafiz Muhammad Jafar

AU - Lee, Benjamin J

AU - Li, Chuanlei

AU - Wei, Wenjie

AU - Huang, Yuhan

AU - Li, Xiang

AU - Fang, Zhengying

AU - Yu, Shuwen

AU - Weng, Qinjie

AU - Ouyang, Yan

AU - Hu, Xiaofan

AU - Tong, Jun

AU - Liu, Jian

AU - Lin, Li

AU - Liu, Mingyu

AU - Xu, Xiaoman

AU - Liu, Dan

AU - Song, Yuan

AU - Lv, Xifeng

AU - Zha, Yixin

AU - Ye, Zhiyin

AU - Jiang, Tingting

AU - Jia, Jieshuang

AU - Chen, Xiaonong

AU - Bi, Yufang

AU - Xue, Jun

AU - Chen, Nan

AU - Hu, Weiguo

AU - He, Cijiang John

AU - Wang, Huiming

AU - Liu, Jun

AU - Xie, Jingyuan

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Acute Kidney Injury/epidemiology

KW - COVID-19/complications

KW - China/epidemiology

KW - Female

KW - Hospitalization

KW - Humans

KW - Hypophosphatemia/complications

KW - Incidence

KW - Intensive Care Units

KW - Kidney Function Tests

KW - Male

KW - Middle Aged

KW - Pneumonia, Viral/complications

KW - Retrospective Studies

KW - Risk Factors

KW - SARS-CoV-2

U2 - 10.1080/0886022X.2021.1979039

DO - 10.1080/0886022X.2021.1979039

M3 - Article

C2 - 34541999

SN - 0886-022X

VL - 43

SP - 1329

EP - 1337

JO - Renal Failure

JF - Renal Failure

IS - 1

ER -

Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection

Abstract

Keywords

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