Mount Sinai Researchers Warn Increase in Chronic Kidney Disease Linked to COVID-19
In Retrospective Analysis, Researchers Review Data of Nearly 4,000 Patients Hospitalized with COVID-19
The results of a large -scale study of nearly 4,000 patients lead by researchers at the Icahn School of Medicine at Mount Sinai suggest that nephrologists will need to prepare for a significant uptick in patients with chronic kidney disease, the result of exposure to the SARS-CoV-2 virus that causes COVID-19. The study was published today in the Journal of the American Society of Nephrology.
“We are grappling with a great deal of uncertainty as to how the virus will impact the kidneys in the long haul,” says principal investigator, Girish Nadkarni, MD. “We may be facing an epidemic of post-COVID-19 kidney disease, and that, in turn, could mean much greater numbers of patients who require kidney dialysis and even transplants.” Dr. Nadkarni is Co- Director of the COVID Informatics Center, Clinical Director of the Hasso Plattner Institute for Digital Health and Assistant Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai.
"In light of the data we have collected about acute kidney injury (AKI) and other kidney
abnormalities associated with COVID-19, our first priority must be to identify patients early and disrupt the progression of kidney disease. We are currently using machine learning to build models that can predict outcomes such as these which will be assessed within Mount Sinai and disseminated to other hospitals across the country," adds Benjamin Glicksberg, PhD, a senior author of the study, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai and the Hasso Plattner Institute for Digital Health.
The need is urgent. “For patients with kidney failure, the prospect of dialysis is one that is life-long, unless a transplant is possible,” says Dr. Nadkarni. “It is terribly hard on the patient, requiring clinic visits three times a week for up to four hours at a time. It is also staff intensive and very costly.”
In their study, Dr. Nadkarni and a team of Mount Sinai researchers describe troubling consequences of COVID–19 on the kidneys, including AKI, which occured in 46 percent of hospitalized patients, one fifth of whom required dialysis. Most striking, in-hospital mortality was 50 percent among patients with AKI, versus 8 percent of patients hospitalized with COVID -19 who did not develop AKI. Only 30 percent of patients who were hospitalized with COVID-19 and developed AKI survived and experienced renal recovery.
The researchers conducted a retrospective observational study of 3,993 Mount Sinai Health System patients hospitalized from February 27, to May 30, 2020, reviewing data from electronic health records of patients older than 18 years with laboratory confirmed COVID-19.
“These findings bring clinical evidence to the hypothesis of lingering organ dysfunction among patients recovering from COVID-19 and serve as a reminder to hospitals around the country to be very strategic in the allocation of resources to care for patients who experience acute kidney injury,” says Dr. Nadkarni.
“The statistics are striking–sadly 35 percent of patients who developed AKI and were discharged from the hospital had no recovery of kidney function at hospital discharge,” says Lili Chan, MD, the study’s lead author. Dr. Chan is Assistant Professor of Medicine (Nephrology), at the Icahn School of Medicine at Mount Sinai. The study also suggests an increasing risk of death among higher stages of AKI, with the highest risk seen in patients with stage 3 AKI who required dialysis.
“This virus continues to be one step ahead of us, and there is still a great deal of uncertainty about how patients who have experienced the ravages of acute kidney injury, combined with the insult of COVID-19, will fare in the long haul. Answers to these questions will require long-term follow-up and investigation,” says Kumardeep Chaudhary, PhD, co-lead author of the study, a postdoctoral fellow at the Icahn School of Medicine at Mount Sinai.
While describing how the Mount Sinai Health System patient population of racially and ethnically diverse New Yorkers fared during the peak of the pandemic, the authors also show a broader picture of a city unprepared. With New York City being the early epicenter of the COVID-19 pandemic not only in the United States but worldwide, the burden of severe AKI reached full tilt. The authors describe widespread shortages of dialysis nurses, machines, replacement fluids, and cartridges for continuous renal replacement therapy and dialysis.
“The sheer number of AKI cases, and the overwhelming need for dialysis that we are seeing in the context of COVID-19, is unprecedented. These findings may help health systems prepare for the high rates of renal dysfunction in incoming COVID-19 patients,” adds Dr. Nadkarni.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai advances medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture ambulatory surgery centers; more than 415 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. The Mount Sinai Hospital is ranked on U.S. News & World Report's "Honor Roll" of the top 20 U.S. hospitals and is top in the nation by specialty: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. Mount Sinai Kravis Children's Hospital is ranked in U.S. News & World Report’s “Best Children’s Hospitals” among the country’s best in four out of 10 pediatric specialties. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and No. 14 in the nation for National Institutes of Health funding. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.