Acute Kidney Injury in Critically Ill Patients Infected With 2009 Pandemic Influenza A(H1N1): Report From a Canadian Province

Abstract

In critically ill patients with pandemic H1N1, kidney injury, kidney failure, and the need for dialysis are common and associated with an increase in mortality and length of intensive care unit stay.

Characteristics of Acute Kidney Injury in Patients Infected with the 2009 Influenza A (H1N1) Virus

“…Concomitant H1N1 infection and AKI was strongly associated with the development of hemodynamic instability during the ICU stay: 79% of our H1N1-infected AKI patients required vasopressor support. Although rhabdomyolysis has been implicated in the development of AKI (3), rhabdomyolysis, as evaluated by creatine kinase levels, was not found to be associated with AKI in our study or in the studies conducted in Canada and Argentina (9,10). It is noteworthy that 100% of our AKI patients had proteinuria.…”

“…In the study conducted in Canada, 11% of the survivors remained on dialysis after hospital discharge (9). In the study presented here, none of the AKI survivors were dialysis dependent at hospital discharge, and by 3 months after hospital discharge, complete recovery of renal function was achieved in 61% of the AKI survivors.…”

“…Mortality rates of 54.6% and 16%, respectively, have been reported among critically ill H1N1-infected patients in Argentina and Canada (9,10). In both of those studies, AKI was associated with higher mortality.…”

“…A history of comorbidities was not associ- ated with AKI. In the study conducted in Canada, the factors associated with AKI were older age, higher body mass index, presence of asthma, and higher APACHE II scores (9). In the study conducted in Argentina, 95.5% of the patients required mechanical ventilation and the following factors were associated with AKI: pregnancy; immunosuppression; high APACHE II, Sequential Organ Failure Assessment, and Murray scores; hemodynamic instability; less time on mechanical ventilation; and thrombocytopenia (10).…”

Acute Kidney Injury due to Rhabdomyolysis in H1N1 Influenza Infection

“…[1][2][3] The incidence of AKI was reported between 30% and 60% in the course of swine flu. 2,4 However, the etiology of AKI has not yet been well described. The authors speculated that all clinical features of influenza virus infection are caused by a virusinduced cytopathy.…”