Fracaso renal agudo en pacientes hospitalizados por COVID-19

Tarragón, Blanca; Valdenebro, María; Serrano, María Luisa Madueño; Maroto, Alba; Llópez-Carratalá, M. Rosario; Ramos, Antonio; Rubio, E. Múñez; Huerta, Ana; Marqués, María; Pórtoles, José

doi:10.1016/j.nefro.2020.08.005

Cited by 30 publications

(19 citation statements)

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“…The mechanisms include ischemic injury due to fluid loss and heart failure, cytokine release syndrome, exposure to nephrotoxins, rhabdomyolysis, microcirculatory thrombi, hypercoagulability, direct podocyte and epithelial lesion, RAAS activation and renal vasoconstriction. 18 , 33 , 34 Consistent with this, in our cohort AKI was more frequent in patients with higher disease severity, higher inflammatory markers and also in patients exposed to nephrotoxins, namely contrast, nonsteroidal anti-inflammatory drugs, vancomycin and aminoglycosides.…”

Section: Discussionsupporting

confidence: 88%

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Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort

Gameiro

Fonseca

Oliveira

et al. 2021

Nefrología (English Edition)

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Introduction The incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients ranges from 0.5% to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19. Methods We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. Results In this cohort of COVID-19 patients, 55.2% developed AKI ( n = 106). The majority of AKI patients had persistent AKI ( n = 64, 60.4%). Overall, in-hospital mortality was 18.2% ( n = 35) and was higher in AKI patients (28.3% vs. 5.9%, p < 0.001, unadjusted OR 6.03 (2.22–16.37), p < 0.001). In this multivariate analysis, older age (adjusted OR 1.07 (95% CI 1.02–1.11), p = 0.004), lower Hb level (adjusted OR 0.78 (95% CI 0.60–0.98), p = 0.035), duration of AKI (adjusted OR 7.34 for persistent AKI (95% CI 2.37–22.72), p = 0.001) and severity of AKI (adjusted OR 2.65 per increase in KDIGO stage (95% CI 1.32–5.33), p = 0.006) were independent predictors of mortality. Conclusion AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

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Section: Discussionsupporting

confidence: 88%

“…In COVID-19 patients, kidney impairment appears to be multifactorial resulting from systemic inflammatory response to volume loss, sepsis, local disruption in renin angiotensin aldosterone system (RAAS) homeostasis, rhabdomyolysis, and it is also suggested that the virus might have direct cytopathic effects. 13 , 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort

Gameiro

Fonseca

Oliveira

et al. 2021

Nefrología (English Edition)

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“…The incidence of AKI in our patients was 19%, in agreement with the incidence reported in previous studies that ranges from 18% to 30.6% [ 28 , 29 ]. Various studies have described AKI in COVID-19 patients and the factors associated with this outcome [ 30 , 31 ]. This phenomenon is probably underestimated in our population.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease

Genovesi

Rebora

Occhino

et al. 2021

JCM

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The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30–59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264–2.373)], older age [HR 1.054 (95%CI 1.044–1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016–1.754)], lower platelet count [HR 0.997 (95%CI 0.996–0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035–1.058)], and higher plasma potassium value 1.374 (95%CI 1.139–1.658)]. When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728–2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022–1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711–4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI.

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“…Queremos transmitir en nombre de todos los autores el agradecimiento por mostrar interés en nuestra publicación como se refleja en su carta al director 1 , 2 .…”

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