COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome

Abstract

Background: The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).Methods: A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.Results: Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.Conclusions: AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Evaluation of mortality of COVID-19 patients with acute kidney injury (AKI) in comparison to the non-AKI patients

“…Based on our results, no significant difference was reported between lung CT-scan and the study groups (P = 0.748). Similar to our results, in the study of Trifi et al, lung CT-scan in the group with and without AKI was not significantly different (P = 0.999) (19). In addition, in the current investigation, no correlation between the stages of AKI and the severity of lung CT-scan results was seen, indicating that variables other than the degree of pulmonary involvement contributed to the development of AKI.…”

“…In the group of patients with AKI, using the mechanical ventilation was higher (P <0.001). While in the study of Trifi et al, the mechanical ventilation usage between the two groups was not significantly different (P = 0.12) (19). There was no significant difference in the mean length of ICU admission between the two groups (P = 0.211).…”

Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19

“…Some previous studies have reported that the incidence of AKI in patients with COVID-19 ranges from 7.2% to 11.5% [3,13,24]. However, other studies showed a higher AKI incidence rate of 44%-52.4% [4][5][6]. These various findings regarding AKI prevalence in patients with COVID-19 may be a result of the differences in various factors, such as disease severity, age of included patients, comorbidities, and hospital admission criteria.…”

“…Concurrently, 15 million confirmed cases of COVID-19 and 19,000 deaths due to COVID-19 are reported in the Republic of Korea [2]. Acute kidney injury (AKI) is the most common and major complication among the various complications associated with COVID-19 infection, and it has been reported to occur in approximately 10-50% of patients with COVID-19 [3][4][5][6]. AKI due to COVID-19 infection increases the risk of death.…”

“…AKI due to COVID-19 infection increases the risk of death. Thus, early detection and appropriate treatment of AKI are required to improve clinical outcomes [4,7].…”