Kidney dysfunction and in-hospital complications in patients with acute cardiovascular pathology infected with COVID-19

Abstract

This study aimed to assess kidney function and its significance for the development of in-hospital complications in patients hospitalized with acute cardiovascular pathology infected with COVID-19.
 Methods. This prospective cohort single-center study included 139 patients with acute cardiovascular pathology diagnosed with COVID-19. Sixty-nine (49.6%) patients had acute coronary syndrome (47 with acute myocardial infarction (AMI), 33 (23.7%) patients had hypertension, 24 (17.3%) patients had acute decompensated heart failure, 9 (6.5%) patients had tachysystolic paroxysms of atrial fibrillation, 2 (1.4%) patients had an acute pulmonary embolism, and 2 (1.4%) patients had syncope. The mean age was 67.9±12.7 years, and 70 (50.4%) patients were male. Arterial hypertension was present in 87.1% of patients, diabetes mellitus in 20.9%, congestive heart failure in 30.9%, chronic obstructive pulmonary disease in 9.4%, AMI in 20.1%, and ischemic stroke in 9.4%.
 Results. The initial creatinine level was 110.7±66.1 μmol/l and eGFR (CKD-EPI) was 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1.73m2 was diagnosed in 46.0% of the patients). The patients with eGFR<60 ml/min/1.73m2 were older, more often female, frequently had a history of atrial fibrillation, had lower hemoglobin and blood pressure on admission, a greater number of complications (need for noninvasive ventilation, inotropic therapy), and higher in-hospital mortality (25.0% vs. 5.3 %, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (increase in creatinine level ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05).
 These patients did not differ significantly in basic clinical and anamnestic data from patients without AKI but had lower spO2 on admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), venous thromboembolism (14.3% vs. 0.9%, p=0.070), death from all causes (47.6% vs. 7.0%, p=0.002) and more often required organ supportive therapy: non-invasive/invasive pulmonary ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57.1% versus 5.2%, p<0.001). Using the simplified criterion of AKI, the category of patients at high risk for hospital complications and death could also be distinguished (37.9% vs. 8.2%, p=0.004). Vaccination against COVID-19 (at least 2 weeks before hospitalization prevented the development of AKI (16.5% vs. 5.0%, p=0.046) and tended to prevent in-hospital mortality (15.7% vs. 5.0%, p=0.076).
 Conclusions. Renal dysfunction in patients with acute cardiovascular pathology infected with COVID-19 is associated with in-hospital complications and can be prevented by prophylactic vaccination.