Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

Abstract

Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure. Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3). Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03–1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20–507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008–1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95–66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10–215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14–0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function. Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection.

Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

“…Previous reports suggested that patients with more severe respiratory disease were at higher risk for developing AKI, with higher incidences seen in patients with ARDS and need for mechanical ventilation [ 28 , 57 , 58 , 59 ]. Although patients with AKD had more frequently a Brescia Score ≥2 in this study, suggesting a more severe disease, it was not associated with higher ICU admission, ARDS incidence or need for mechanical ventilation, meaning that the severity of the lung damage did not correlate with the persistence of the kidney damage.…”

Catechins: Therapeutic Perspectives in COVID-19-Associated Acute Kidney Injury

“…AKI has been shown to develop in COVID-19 patients 5 to 9 days after hospital admission and mostly in patients with severe COVID-19 disease [ 107 , 108 ]. In general, elevated levels of SCr and blood urea nitrogen (BUN) and reduced GFR were reported in COVID-19 patients following hospital admission, whereas an increase in SCr accompanied by proteinuria or hematuria was observed in 7–63% and 26.7% of cases, respectively [ 20 , 109 , 110 , 111 ].…”

Inappropriate Heart Rate Response to Hypotension in Critically Ill COVID-19-Associated Acute Kidney Injury

“…Severe acute kidney injury (AKI) is a frequent condition in critically ill coronavirus infectious disease 2019 (COVID-19) patients [3]. AKI participates in a specific phenotype of severe disease, associated with higher hospital mortality and length of stay [3,4].…”

“…Severe acute kidney injury (AKI) is a frequent condition in critically ill coronavirus infectious disease 2019 (COVID-19) patients [3]. AKI participates in a specific phenotype of severe disease, associated with higher hospital mortality and length of stay [3,4]. Acute arterial hypotension is a common side effect of continuous venovenous hemodiafiltration with net ultrafiltration (CVVHDF-induced hypotension [5]) usually used for COVID-19associated severe AKI [4,6,7].…”