Fluid Resuscitation and Progression to Renal Replacement Therapy in Patients With COVID-19

Holt, Daniel B.; Lardaro, Thomas; Wang, Alfred Z.; Musey, Paul I.; Trigonis, Russell; Bucca, Antonino; Croft, Alexander; Glober, Nancy; Peterson, Kelli; Schaffer, Jason T.; Hunter, Benton R.

doi:10.1016/j.jemermed.2021.10.026

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…In fact, daily cumulative FB was significantly higher in wave 1 than in wave 2 despite using diuretics more often. This is in keeping with results from non-COVID-19 studies showing that higher FB is associated with more AKI and higher need for KRT and longer durations of KRT [ 27 , 40 – 44 ].…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 81%

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Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Lumlertgul

Baker

Pearson

et al. 2022

Ann. Intensive Care

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Background Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK). Methods This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared. Results A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001). Conclusions In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB. Trial registration: NCT04445259.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 81%

Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Lumlertgul

Baker

Pearson

et al. 2022

Ann. Intensive Care

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“…It has been known that higher BMI is associated with higher incidence of AKI in ARDS patients [ 26 ]. Moreover, studies have identified additional factors linked to kidney injury that necessitate RRT, including CKD [ 14 ], history of transplantation [ 27 ], and high creatinine levels [ 28 ]. Higher stages of AKI are often associated with higher risk of hypercatabolism.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy

Choi,

Kim,

Park

et al. 2024

PLoS ONE

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Background The coronavirus disease (COVID-19) pandemic has significantly strained global healthcare, particularly in the management of patients requiring mechanical ventilation (MV) and continuous renal replacement therapy (CRRT). This study investigated the characteristics and prognoses of these patients. Methods This multicenter retrospective cohort study gathered data from patients with COVID-19 across 26 medical centers. Logistic analysis was used to identify the factors associated with CRRT implementation. Results Of the 640 patients with COVID-19 who required MV, 123 (19.2%) underwent CRRT. Compared to the non-CRRT group, the CRRT group was older and exhibited higher sequential organ failure assessment scores. The incidence of hypertension, diabetes, cardiovascular disease, chronic neurological disease, and chronic kidney disease was also higher in the CRRT group. Moreover, the CRRT group had higher intensive care unit (ICU) (75.6% vs. 26.9%, p < 0.001) and in-hospital (79.7% vs. 29.6%, p < 0.001) mortality rates. CRRT implementation was identified as an independent risk factor for both ICU mortality (hazard ratio [HR]:1.833, 95% confidence interval [CI]:1.342–2.505, p < 0.001) and in-hospital mortality (HR: 2.228, 95% CI: 1.648–3.014, p < 0.001). Refractory respiratory failure (n = 99, 19.1%) was the most common cause of death in the non-CRRT death group, and shock with multi-organ failure (n = 50, 40.7%) was the most common cause of death in the CRRT death group. Shock with multi-organ failure and cardiac death were significantly more common in the CRRT death group, compared to non-CRRT death group. Conclusion This study indicates that CRRT is associated with higher ICU and in-hospital mortality rates in patients with COVID-19 who require MV. Notably, the primary cause of death in the CRRT group was shock with multi-organ failure, emphasizing the severe clinical course for these patients, while refractory respiratory failure was most common in non-CRRT patients.

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“…However, this strategy has recurrently been insufficient to effectively regulate blood pressure [ 84 , 85 ]. The dose of resuscitation fluid administered to ICU patients is associated with the gravity of the patient’s condition [ 30 , 86 ]. Notably, the oxHDL levels directly correlate with the resuscitation fluid dose, suggesting an association between both parameters.…”

Section: Discussionmentioning

confidence: 99%

Oxidized High-Density Lipoprotein Induces Endothelial Fibrosis Promoting Hyperpermeability, Hypotension, and Increased Mortality

Rojas

Prado

Tapía³

et al. 2022

Antioxidants

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During systemic inflammation, reactive oxygen species (ROS) are generated in the bloodstream, producing large amounts of oxidized HDL (oxHDL). OxHDL loses the vascular protective features of native HDL, acquiring detrimental actions. Systemic inflammation promotes endothelial fibrosis, characterized by adhesion protein downregulation and fibrotic-specific gene upregulation, disrupting endothelial monolayer integrity. Severe systemic inflammatory conditions, as found in critically ill patients in the intensive care unit (ICU), exhibit endothelial hyperpermeability, hypotension, and organ hypoperfusion, promoting organ dysfunction and increased mortality. Because endothelial fibrosis disturbs the endothelium, it is proposed that it is the cellular and molecular origin of endothelial hyperpermeability and the subsequent deleterious consequences. However, whether oxHDL is involved in this process is unknown. The aim of this study was to investigate the fibrotic effect of oxHDL on the endothelium, to elucidate the underlying molecular and cellular mechanism, and to determine its effects on vascular permeability, blood pressure, and mortality. The results showed that oxHDL induces endothelial fibrosis through the LOX-1/NOX-2/ROS/NF-κB pathway, TGF-β secretion, and ALK-5/Smad activation. OxHDL-treated rats showed endothelial hyperpermeability, hypotension, and an enhanced risk of death and mortality, which was prevented using an ALK-5 inhibitor and antioxidant diet consumption. Additionally, the ICU patients showed fibrotic endothelial cells, and the resuscitation fluid volume administered correlated with the plasma oxHDL levels associated with an elevated risk of death and mortality. We conclude that oxHDL generates endothelial fibrosis, impacting blood pressure regulation and survival.

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Fluid Resuscitation and Progression to Renal Replacement Therapy in Patients With COVID-19

Cited by 4 publications

References 18 publications

Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy

Oxidized High-Density Lipoprotein Induces Endothelial Fibrosis Promoting Hyperpermeability, Hypotension, and Increased Mortality

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