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 Connor, Kathleen D. Liu, Marlies Ostermann, Thomas Rimmelé, Alexander Zarbock, Samira Bell, Azra Bihorac, Vincenzo Cantaluppi, Eric A. J. 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, Xosé Pérez-Fernández, Peter Pickkers, John R. Prowle, Thiago Reis, Nattachai Srisawat, Ashita Tolwani, Anitha Vijayan, Gianluca Villa, Li Yang, Claudio Ronco, John A. Kellum
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.