Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil

Abstract

<b><i>Background:</i></b> Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. <b><i>Methods:</i></b> We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. <b><i>Results:</i></b> 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33–4.69], <i>p</i> = 0.005), diuretic use (OR 4.14 [1.27–13.49], <i>p</i> = 0.019), and IMV (OR 7.60 [1.37–42.05], <i>p</i> = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16–4.33], <i>p</i> = 0.023). Overall 60-day mortality was 14.4% {23.8% (<i>n</i> = 24) in the AKI group versus 5% (<i>n</i> = 5) in the non-AKI group (HR 2.79 [1.04–7.49], <i>p</i> = 0.040); and 35.3% (<i>n</i> = 12) in the RRT group versus 10.2% (<i>n</i> = 17) in the non-RRT group, respectively (HR 2.21 [1.01–4.85], <i>p</i> = 0.047)}. <b><i>Conclusions:</i></b> AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.

Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study

“…69.3% and 65.3% of AKI patients required mechanical ventilation and vasopressors, respectively. In addition, the 60day AKI mortality and 60-day AKI-RRT mortality rates were 23.8% and 35.3%, respectively [3]. Possible reasons for this much lower mortality than has been found in other studies could be the lower prevalence of KDIGO stage 3, the short time interval between COVID-19 symptom onset and ICU admission (only 1 day), and the study setting (private medical service with better resources).…”

“…Nephrologists have witnessed that, as in other infectious diseases, acute kidney injury is a frequent complication of SARS-CoV-2, especially in its most severe forms. Current data demonstrate a prevalence of up to 56.9% of acute kidney injury among hospitalized patients with SARS-CoV-2 and mortality that varies widely (23.8-97.2%) depending on the characteristics of the sample [3,4]. It has been suggested that COVID-19 associated AKI has a worse prognosis in comparison to other AKI etiologies [5].…”

Acute Kidney Injury Due to COVID-19 in Intensive Care Unit: An Analysis From a Latin-American Center

“…In an English multicentric series (32) of 1,032 inpatients, of which 165 were in the ICU, the incidence of AKI in critical patients was 44.2% with a higher mortality in patients with AKI compared with non-AKI patients (52.1 vs. 22.8, p < 0.001) with similar results observed in French patients (33). In a Brazilian single-center study (34) with 201 ICU patients, 101 (50.2%) developed AKI and 32 (17%) required dialysis. The overall mortality was 14.4%, being higher in the AKI group of patients.…”

“…Due to the preserved diuresis, such patients did not develop uremia, hypervolemia, or other hydroelectrolytic disorders that required dialysis treatment. Regarding risk factors for mortality in COVID-19 patients, another case series (29)(30)(31)34) found a correlation between obesity and mortality. This finding was not evidenced in our cohort; however, only 30.5% of the patients had an obesity diagnosis with most of them having a BMI in the range from 24.7 to 30.4 kg/m 2 (p25; p75), differently from those from other series in which the obesity percentage and the BMI values were both higher.…”

“…Risk factors for AKI in critical patients with COVID-19 vary according to the population. Older age, male gender, black race, obesity, diabetes, hypertension, heart failure, chronic kidney disease, leukocytosis, anemia, lymphopenia, increase in levels of serum inflammatory markers (D-dimer, PCR, and IL-6), and need for mechanical ventilation and vasoactive drugs as well as the use of angiotensin-converting enzyme inhibitors were associated with a higher risk of AKI development in COVID-19 critical patients (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Herein, chronic kidney disease was more frequent in patients who developed AKI (18.5 vs. 14.6%), however with no statistical significance.…”