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Background: Acute kidney injury is a severe complication of COVID-19. Both COVID-19 and related acute kidney injury are reported in the literature to be more prevalent and more severe in males.Methods: We performed a retrospective analysis of the COVID-19 associated acute kidney injury cases in order to search for differences between genders regarding patients' and renal outcome.Results: 250 patients with acute kidney injury were included in the study: 93 women (37.20%), 157 men (62.80%). There were no differences between sexes regarding age. Diabetes mellitus was significantly more present in women. Peak ferritin and procalcitonin levels were significantly higher in men, but other severity markers for COVID-19 did not differ between genders. There were no differences between sexes regarding history of chronic kidney disease, timing of acute kidney injury, need for dialysis or recovery of renal function. ICU admission and in-hospital mortality were similar between men and women.Conclusions: In our study, COVID-19 related-AKI was more prevalent in men than in women, but the patients' and renal outcome were similar. Significantly higher ferritin and procalcitonin serum levels registered in male patients when compared to women may have additional explanations beside more severe SARS-CoV-2 infection in males.
ABSTRACT
BACKGROUND AND AIMS: During a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality. METHOD: In a retrospective analysis, we included 268 adult patients with RT-PCRconfirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria. RESULTS: In our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization. Statistic analysis using the Mann-Whitney U-test revealed significant differences (P < .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h;P = .35) and fibrinogen (629 versus 645 mg/dL;P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc;P = .80). The analysis using Fisher's exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) (Table 1). In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003-1.011). CONCLUSION: Mortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.
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BACKGROUND AND AIMS: Acute kidney injury (AKI) is a potential complication of COVID-19 and the hypercoagulation tendency of SARS-CoV-2 infection is considered one of the underlying mechanisms. Fibrinolysis markers have been described as severity parameters, independent of clinically manifested thromboembolic events. The aim of this study is to evaluate the contribution of D-dimer testing in appreciating the extent of AKI and renal function recovery in COVID-19. METHOD: We have conducted a retrospective study on 253 AKI adult patients confirmed with SARS-CoV-2 infection by molecular testing and hospitalized in two emergency university hospitals over the course of 6 months. Diagnosis and staging of AKI were performed with KDIGO 2012 criteria. We analysed the impact of peak D-dimers on the severity of AKI, recovery of renal function and need for renal replacement therapy (RRT). Additionally, we searched the relationship between D-dimers and survival and COVID-19 severity parameters. Severity of respiratory failure was classified as mild-moderate (no support or low-flow oxygen) and severe (mechanical ventilation: continuous positive airway pressure and endotracheal intubation). All data was analysed using IBM SPSS Statistics v.25 (IBM, Corp.). RESULTS: The average age was 72.4 ± 13.33 years, 159 patients were male (62.84%). According to KDIGO staging, 79 patients were in stage 1, 74 in stage 2 and 100 patients in stage 3. Overall mortality was 50.59% (N = 128). The mean peak of Ddimers was 6.08 ± 6.53 μg/mL. We found a significant direct relationship between D-dimers and AKI stage (3.72 ± 5.84 μg/mL-stage 1;6.67 ± 6.60 μg/mL- stage 2;7.50 ± 6.46 μg/mL-stage 3;P < .0001). There was a significant inverse relationship between D-dimers and odds of renal recovery, lower values being noted in the complete renal recovery group (3.79 ± 5.10 μg/mL, N = 77) compared with partial recovery (5.22 ± 6.89 μg/mL, N = 57;P < .02), while D-dimers were strikingly high in patients needing RRT (8.11 ± 5.92 μg/mL, N = 29). Regarding the severity of respiratory failure, we found that mild-moderate cases had lower D-dimers (4.23 ± 5.46 μg/mL, N = 146) compared with severe failure (8.60 ± 7.00 μg/mL, N = 107;P < .003). Intensive care unit (ICU) admission was also correlated with levels of D-dimers (8.55 ± 6.76 μg/mL, N = 107 versus non-ICU 4.27 ± 5.70 μg/mL, N = 146;P < .01). D-dimers were higher in deceased patients (7.91 ± 6.60 μg/mL) compared with survivors (4.20 ± 5.88 μg/mL;P < 0.001) (Table 1). CONCLUSION: Increased D-dimer levels in COVID-19-associated AKI have a negative impact on the severity of AKI, need for RRT and recovery of renal function. AKI patients with high levels of D-dimers are more often admitted to the ICU, have an increased need for mechanical ventilation and have poor survival. Due to the additional negative impact of AKI in COVID-19 and possible preventability of severe disease, D-dimers may be a useful tool to assess the need and duration of adequate prophylactic anticoagulation. . (Table Presented).
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Limiting autopsies in deaths caused by COVID-19 reduced our ability to gain knowledge regarding many aspects of this lethal disease and also to answer potential medico-legal issues. Accordingly, it upraised the importance of the careful analysis of the clinical and biochemical determinants of the fatal evolution in SARS-CoV-2 infected patients. Maintenance dialysis patients, associating many comorbid conditions and an immunosuppressed status, are prone to a severe outcome of this disease. Since we were designated as a hospital dedicated exclusively to moderate/severe COVID-19 infections, we conducted an observational, single-center study in the Nephrology and Dialysis Department, aiming the analysis of mortality risk factors and determinants in maintenance hemodialysis patients admitted for this infection, which we discuss along with a focused review of the similar experiences in the last year's literature.