Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019

Abstract

Background Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported. Methods Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated. Results Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12–23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54–140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively. Conclusion Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.

Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury

“…Published studies on AKI in COVID- 19 have thus far been hindered by relatively small sample sizes or incomplete clinical courses with patients still receiving treatment in the hospital. [7][8][9][10] As recovery from COVID-19, especially when severe, often takes weeks in the hospital, previously published studies may result in a skewed view of endpoints, potentially biasing toward adverse outcomes. [11][12][13] Additionally, prior publications have not addressed varied timelines of AKI development during hospitalization or the varied duration of follow-up.…”

Acute kidney injury in hospitalized patients with COVID-19

“…22 Rubin et al analyzed AKI in 77 critically ill patients with COVID-19 and demonstrated that persistent AKI was present in the majority of patients (93%). 44 In their study, clinical and laboratory characteristics were similar between patients with persistent and transient AKI. 44 These ndings were also present in our cohort.…”

“…44 In their study, clinical and laboratory characteristics were similar between patients with persistent and transient AKI. 44 These ndings were also present in our cohort.…”

Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology

“…It is worth to highlight that the mortality was lower in patients with CKD than in patients without CKD. Within the analysis of this study a hypothesis is generated, that the natural immunosuppressive state in CKD patients may protect against the cytokine storm by COVID-19 [13][14][15], that is present in patients that are previously healthy without any immunosuppression. However, randomized clinical trials have to be made to corroborate the latter, given that for now, only studies with descriptive methodology have been published.…”