Severe acute kidney injury in critically ill COVID-19 patients

Background Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored. Methods Prospective observational study of COVID-19 patients ad...

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Bibliographic Details
Published in:Journal of nephrology 2021-04, Vol.34 (2), p.285-293
Main Authors: Piñeiro, Gaston J., Molina-Andújar, Alicia, Hermida, Evelyn, Blasco, Miquel, Quintana, Luis F., Rojas, Guido Muñoz, Mercadal, Jordi, Castro, Pedro, Sandoval, Elena, Andrea, Rut, Fernández, Javier, Badia, Joan Ramon, Soriano, Alex, Poch, Esteban
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - epidemiology
Acute Kidney Injury - etiology
Aged
COVID-19 - complications
COVID-19 - epidemiology
Critical Illness
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitalization - trends
Humans
Incidence
Intensive Care Units - statistics & numerical data
Male
Medicine
Medicine & Public Health
Nephrology
Original
Original Article
Pandemics
Prospective Studies
Renal Replacement Therapy - methods
Risk Factors
SARS-CoV-2
Spain - epidemiology
Urology
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Summary:Background Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored. Methods Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients. Results During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02–0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024). Conclusions The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
ISSN:1121-8428
1724-6059
DOI:10.1007/s40620-020-00918-7