Evaluation of Predictors, Kinetics of Renal Recovery and Outcomes of COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study

Abstract

A bstract Background The incidence of acute kidney injury (AKI) is greater than 50% among coronavirus disease-2019 (COVID-19) patients admitted to the intensive care unit (ICU). However, the literature on predictors and kinetics of renal recovery remains unclear. Patients and methods This observational study was conducted in a 30-bedded mixed ICU of a tertiary care center from May 2020 to July 2021. A total of 200 consecutive adult COVID-19 patients who had AKI in ICU were included. Using logistic regression with the best subset selection, predictors of renal recovery were identified. Outcomes and kinetics of AKI recovery were determined. Results Among 200 patients, 67 recovered from AKI, of which 38, 17, and 12 patients had transient AKI, persistent AKI, and acute kidney disease (AKD), respectively. A total of 25 patients had AKI relapse, primarily associated with hospital-acquired infections. Results of logistic regression showed that the combination of Acute Physiology and Chronic Health Evaluation (APACHE II) {odds ratio (OR) 1.1 [ p < 0.001; 95% confidence interval (CI) 1.06–1.16]}, day onset of AKI [OR 1.6 ( p = 0.001; 1.24–2.24)] and severity of AKI [OR 2.9 ( p < 0.001; 2.03–4.36)] were the predictors associated with poor renal recovery. This model had sufficient discrimination with the area under the curve (AUC) of 0.86. Renal replacement therapy requirement and mortality among COVID–AKI patients were 68 and 84%, respectively. Conclusion A higher APACHE II at admission, a longer time to onset of AKI, and the severity of AKI during ICU stay predicted poor renal recovery. Study results emphasize the need for stepping-up dialysis resources in the likely case of future waves of COVID-19. The relapse of AKI was associated with sepsis, and mortality rates were substantially high. How to cite this article Gudivada KK, Narayan SK, Narasimha A, Krishna B, Muralidhara KD. Evaluation of Predictors, Kinetics of Renal Recovery and Outcomes of COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2022;26(12):1293–1299.

The Time-Varying Impact of COVID-19 on the Acute Kidney Disorders: A Historical Matched Cohort Study and Mendelian Randomization Analysis

“…The incidence rate of acute kidney injury (AKI) can reach 41% to 62% [ 6 – 9 ] in patients with COVID-19. Despite the high incidence of AKI, research has revealed that the majority of patients can recover within the first week (the median number of days to recover from AKI is 6) following infection [ 10 ]. Studies also suggest that patients with COVID-19 with longer AKI recovery times have a higher incidence of chronic kidney disease (CKD) [ 11 ].…”

Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study

“…[ 7 ]. At the same time, COV-AKI has been shown to be a predictor of mortality [ 8 ] and for survivors, renal recovery varies according to the operational definition used in different studies, but remains lower when compared with other causes of AKI [ 9 ]. AKI was found to be also a predictor for readmission and mortality in COVID-19 patients discharged early from the hospital [ 10 ].…”