Acute Kidney Injury in Elderly Patients With Coronavirus Infectious Disease: A Study of Incidence, Risk Factors, and Prognosis in Brazil

Yuasa, Bruna Kaori; Magalhães, Luís Eduardo; Oliveira, Paula Gabriela Sousa de; Yokota, Laís Gabriela; Cardoso, Pedro Andriolo; Zamoner, Welder; Balbi, André Luís; Ponce, Daniela

doi:10.3389/fneph.2022.896891

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…AKI could be related to different causes including direct viral effects on kidney tissue, septicemia, medication side effects and the systemic inflammatory response to COVID-19 [34]. AKI is more common among geriatric patients with COVID-19 and commonly associated with a higher risk of mortality [35]…”

Section: Discussionmentioning

confidence: 99%

Blood Urea Nitrogen to Albumin Ratio is a Predictor of Mortality among Hospitalized Geriatric Patients with COVID-19.

al.¹

2022

The Egyptian Journal of Geriatrics and Gerontology

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Aim: This study aims to determine predictors of mortality among hospitalized geriatric patients with COVID-19 with a particular concern about the predictive value of blood urea nitrogen to albumin ratio (BAR). Methods: A retrospective cohort study included 114 geriatric patients (aged ≥ 60 years) admitted to a geriatrics hospital for isolation. A review of the medical files of participants was conducted to extract data regarding age, sex, comorbidities, clinical manifestations of COVID-19 and laboratory data including haematology, biochemistry and inflammatory markers on admission. BAR and Charlson comorbidity index (CCI) were calculated. The primary outcome was in-hospital mortality. Appropriate statistical analyses were operated. RESULTS: 59 (51.8%) patients died at the hospital. Comorbidities associated with mortality included diabetes mellitus, old stroke, hypertension, and cardiac disease besides higher CCI. Reporting of fever, fatigue, sore throat and delirium /altered mental status were also associated with mortality. Significant biomarkers included lower hemoglobin and serum albumin, higher total leukocyte count, serum creatinine, blood urea nitrogen, lactate dehydrogenase, D-dimer, c-reactive protein (CRP) and BAR. BAR at a cutoff of 12.92 mg/gm had the best predictive performance for mortality. Serum BAR > 12.92 mg/gm, albumin < 3.05 g/dl and CRP > 108 mg/l were independent predictors of in-hospital mortality CONCLUSION: Serum BAR > 12.92 mg/gm, albumin < 3.05 g/dl and CRP > 108 mg/l are independent predictors of mortality among hospitalized geriatric patients with COVID-19. BAR is a convenient biomarker and has the best predictive performance to early pick up COVID-19 geriatric patients at high risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Blood Urea Nitrogen to Albumin Ratio is a Predictor of Mortality among Hospitalized Geriatric Patients with COVID-19.

al.¹

2022

The Egyptian Journal of Geriatrics and Gerontology

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Impact of Clinical Aspects and Pathophysiology Mechanisms of Acute Kidney Injury on Outcomes of Patients Affected by COVID-19—A Retrospective Cohort Study

Cardoso,

Yuasa,

Magalhães

et al. 2024

COVID

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Introduction: COVID-19, caused by the SARS-CoV-2 virus, has been associated with oligosymptomatic cases or severe acute respiratory syndrome, with multiple organ failure and death. One of the most significant events for clinical outcomes is Acute Kidney Injury (AKI). It is known that AKI in COVID-19 is multifactorial, and the main mechanisms are cytokine storm, metabolic stress, use of nephrotoxic drugs, rhabdomyolysis, viral tropism to kidney tissues, and multiple organ failure. However, little is known about the impact of AKI clinical presentation and pathophysiological mechanisms on the outcome of patients affected by COVID-19. Objectives: To identify AKI clinical presentation and etiology, also known as phenotypes, and pathophysiological mechanisms, also known as subphenotypes, in patients affected by COVID-19 and associate them with death. This cohort and retrospective study evaluate the medical records of patients with SARS-CoV-2 infection admitted to a tertiary public hospital from 1 June 2020, to 31 July 2021, from admission to clinical outcome (hospital discharge or death). Clinical and laboratory data were analyzed during the hospitalization. Renal function was estimated by urine output and serum creatinine; therefore, the diagnosis and AKI classification were based on the 2012 KDIGO criteria. The occurrence of AKI was the inclusion criterion. According to clinical and laboratory presentations, we recognized two phenotypes of AKI (the direct and indirect impact of SARS-CoV-2 on the kidney) and several pathophysiological mechanisms. Subphenotypes of the direct impact of SARS-CoV-2 on kidneys were associated with Kidney Viral Tropism, Cytokine Storm, COVID-19-Related Multiple Organ Failure, and Mixed (more than one mechanism associated with COVID-19). Subphenotypes of indirect impact of SARS-CoV-2 on kidney phenotypes were Ischemic, Nephrotoxic due to rhabdomyolysis, and Septic. Univariate and multivariate analyses were performed to identify risk factors associated with death. Result: In total, 372 patients were included; 55.6% were male, 82.3% were Caucasians, and the mean age was 61.4 years. The majority of patients were admitted to the ICU (88.2%) and required mechanical ventilation (86.3%). AKI was predominantly KDIGO 3 (65.6%). When classifying our patients’ AKI in two kidney phenotypes based on their clinical presentation, the direct impact of the SARS-CoV-2 phenotype was predominant (71,5%) and associated with higher mortality (83.8 vs. 46.3%, p = 0.001). Among the AKI pathophysiological mechanisms, Mixed—synergism of viral mechanisms—was the most prevalent (23.4%), followed by Viral Tropism (19.9%), Multiple Organ Failure—MOF (18%), Septic (15.6%), Ischemic (12.9%), and Cytokine Storm (10.2%). Mortality was high (73.1%). Logistic regression identified APACHE II, ATN-ISS, and the direct impact of SARS-CoV-2 on the kidney as factors associated with death, while ischemic AKI was associated with lower mortality. Conclusions: We can conclude that APACHE II and ATN-ISS scoring are clinical predictions of hospital mortality in COVID patients with AKI, as well as AKI etiology involving the direct impact of SARS-CoV-2 on the kidney, while ischemic pathophysiological mechanisms of AKI are associated with lower mortality.

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The Renal Manifestations of SARS-CoV-2: A Guide for Family Physicians

Morrissey

Elzinad

Hayek

et al. 2023

IJTM

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COVID-19 is a devastating systemic disease characterized by multisystem involvement driven by exuberant hyperinflammatory and dysregulations in coagulation. In COVID-19 patients, renal failure contributes to morbidity and mortality, and its early detection and timely management are critical to minimize such untoward and irreversible complications. In the healthcare system, family physicians constitute the first node in the management of patients, yet there is a dearth of reports and guidelines focusing on them for specific organ affection. This review provides an overview of recent studies examining the renal manifestations following SARS-CoV-2 infection. We focus on the tell-tale signs and laboratory findings of renal affection in the pediatric and adult populations with COVID-19, specifically for family practitioners to assist in their appropriate triage. Among different manifestations, urinary abnormalities and a modest increase in creatinine are the early indicators of renal affection in COVID-19 patients. Although renal transplant patients are conventionally managed by specialized teams, they may present to family physicians during a pandemic. This review provides a framework for family physicians to promptly detect early indicators of renal involvement in patients infected with SARS-CoV-2, including providing triage guidance for kidney transplant recipients.

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Acute Kidney Injury in Elderly Patients With Coronavirus Infectious Disease: A Study of Incidence, Risk Factors, and Prognosis in Brazil

Cited by 3 publications

References 15 publications

Blood Urea Nitrogen to Albumin Ratio is a Predictor of Mortality among Hospitalized Geriatric Patients with COVID-19.

Blood Urea Nitrogen to Albumin Ratio is a Predictor of Mortality among Hospitalized Geriatric Patients with COVID-19.

Impact of Clinical Aspects and Pathophysiology Mechanisms of Acute Kidney Injury on Outcomes of Patients Affected by COVID-19—A Retrospective Cohort Study

The Renal Manifestations of SARS-CoV-2: A Guide for Family Physicians

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