Acute kidney injury in critically ill COVID-19 infected patients requiring dialysis: experience from India and Pakistan

Abstract

Background Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital. Methods The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality. Results A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality. Conclusion There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.

Impact of CRRT on the outcome of critically ill Covid-19 infected patients with acute kidney injury. A retrospective observational cross-sectional study

“…To further support our results, Anees A. Sindi in 2023, had reached a conclusion that the use of renal replacement therapy among critically ill COVID-19 patients could potentially predict worse outcomes (29). Furthermore, Urmila Anandh and colleagues concluded that AKI requiring CRRT in critically ill COVID-19 pneumonia patients had a high mortality which was independently predicted by age, altered sensorium at presentation, need for ventilatory support and CRRT (30).…”

Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study, Saudi Arabia

“…In one study it was reported that up to 20% of patients underwent renal replacement therapy (KRT) [5]. This is in contrast to a study from India and Pakistan, which reported that CRRT was required in 22.9% of cases [35]. The incidence of AKI was 43.7%, and 18.2% of patients underwent CRRT, and in this group, 90-day in-hospital mortality was 45.1%.…”

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

“… 12 , 27 , 28 The LLMIC incidence (53%), has also been reported in small cohorts of both critical and noncritical hospitalized patients from India and Pakistan. 29 , 30 Higher incidences of AKI (up to 85%) have been reported in HIC ICU patient studies that include the urine output component of the Kidney Disease Improving Global Outcomes definition, suggesting that combining both elements of the definition captures a far broader class of patients than considered here. 26 , 31 …”