Factors associated with acute kidney injury in acute respiratory distress syndrome

Abstract

Background Acute kidney injury (AKI) is the most frequent extra-pulmonary organ failure in acute respiratory distress syndrome (ARDS). The objective of this study was to assess the factors associated with the development and severity of AKI in patients with ARDS. Methods This is a retrospective cohort study of ARDS patients without acute or chronic kidney disease prior to the onset of ARDS over a 7-year period (2010–2017). AKI and severity of AKI were defined according to the Kidney Disease Improving Global Outcomes 2012 guidelines. Results Of the 634 ARDS patients, 357 patients met study criteria. A total of 244 (68.3%) patients developed AKI after ARDS onset: 60 (24.6%) had stage I AKI, 66 (27%) had stage II AKI, and 118 (48.4%) had stage III AKI. The median time of AKI onset for stage I AKI was 2 days (interquartile range, 1.5–5.5) while stage II and III AKI was 4 days. On multivariable analysis, factors associated with development of AKI were age [subdistribution hazard ratio (SHR) 1.01, 95% confidence interval (CI) 1.00–1.02], SOFA score (SHR 1.16, 95%CI 1.12–1.21), a history of diabetes mellitus (DM) (SHR 1.42, 95%CI 1.07–1.89), and arterial pH on day 1 of ARDS (SHR per 0.1 units decrease was 1.18, 95%CI 1.05–1.32). In severity of AKI, stage I AKI was associated with age (SHR 1.03, 95%CI 1.01–1.05) and serum bicarbonate on day 1 of ARDS (SHR 1.07, 95%CI 1.02–1.13). Stage II AKI was associated with age (SHR 1.03, 95%CI 1.01–1.05), serum bicarbonate on day 1 (SHR 1.12, 95%CI 1.06–1.18), SOFA score (SHR 1.19, 95%CI 1.10–1.30), history of heart failure (SHR 3.71, 95%CI 1.63–8.46), and peak airway pressure (SHR 1.04, 95%CI 1.00–1.07). Stage III AKI was associated with a higher BMI (SHR 1.02, 95%CI 1.00–1.03), a history of DM (SHR 1.79, 95%CI 1.18–2.72), SOFA score (SHR 1.29, 95%CI 1.22–1.36), and arterial pH on day 1 (SHR per 0.1 units decrease was 1.25, 95%CI 1.05–1.49). Conclusions Age, a higher severity of illness, a history of diabetes, and acidosis were associated with development of AKI in ARDS patients. Severity of AKI was further associated with BMI, history of heart failure, and peak airway pressure. Electronic supplementary material The online version of this article (10.1186/s13613-019-0552-5) contains supplementary material, which is available to authorized users.

Kidney involvement in COVID-19 and rationale for extracorporeal therapies

“…Recent findings confirmed the close relationship between alveolar and tubular damage -the lung-kidney axisin ARDS 8 . In 2019, a retrospective study that included 357 patients with ARDS who did not have chronic kidney disease or AKI before ARDS presentation reported that pneumonia was the cause of ARDS in 83% of patients, and 68% of patients developed AKI 8 . Stage 3 AKI occurred in almost half of the patients with kidney injury.…”

“…cytokine removal could prevent CRSinduced organ damage nature reviews | NePhrOlOgy positively associated with older age, higher body mass index, diabetes mellitus, history of heart failure, higher peak airway pressure and higher sequential organ failure assessment. Positive end-expiratory pressure and prone positioning were not associated with kidney impairment, and nephrotoxic agents were not associated with clinical AKI 8 .…”

“…An excessively high concentration of anti-inflammatory mediators might be harmful as it could predispose the patient to a state of relative immunosuppression. Clearly, a huge difference exists in the prevalence of AKI in patients with ARDS secondary to COVID-19 pneumonia (4.5%) 4 compared with ARDS due to pneumonia with other causes (68%) 8 . The reasons for this difference are yet to be elucidated.…”

SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

“…Elevation of central venous pressure due to high intrathoracic pressures may result in an increased kidney hydrostatic pressure, which leads to glomerular ltration impairment (32,33). Patients in both groups (AKI or non-AKI) presented similar PaO2/FiO2 ratios, indicating that the severity of the lung impairment is independent of kidney injury and, thus, reinforcing the importance of a tight controlled and tailored PEEP level.…”

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

“…A 2004-2012 systematic review that included large-scale cohort studies has estimated the global incidence of AKI to be 21.6% in adults (95% CI, 19.3 to 24.1), and 31.7% (95% CI, 28.6 to 35.0) in critical care settings, according to the KDIGO guideline (14). However, a recent study which enrolled 634 patients with ARDS demonstrated that an incidence rate of 68.3% for AKI after the onset of ARDS (15). In another observational study on the critically ill patients with 2009 in uenza A (H1N1) viral pneumonia, the incidence of AKI reached to 51% (16).…”