ABSTRACT
Background: Infection with severe acute respiratory syndrome coronavirus 2 has resulted in a global pandemic. The objective of this study was to investigate the prevalence, causes, and clinical implications of magnesium disturbances, including their possible association with treatment outcomes, among patients with COVID-19. Method(s): This cohort study was conducted at the Hospital das Clinicas, a tertiary care academic medical center in the city of Sao Paulo, Brazil. We included only patients diagnosed with COVID-19, and all clinical data were extracted from medical records. The patients were classified as having hypomagnesemia (HypoMg, plasma Mg <= 1.58 mg/dL) or hypermagnesemia (HyperMg, plasma Mg >= 2.55 mg/dL), and the groups were compared in terms of clinical features and outcomes. We analyzed data collected at admission, <= 72 h after admission, or both. Result(s): We analyzed 3,777 patients. Data regarding magnesium levels were available for 3,162 of those patients, and 344 (10.9%) were found to have HyperMg (240 men and 104 women). The mean age of the HyperMg group patients was 62.2 +/- 0.8 years (range, 15-98 years). Of the HyperMg group patients, 54% died during hospitalization, 86% required mechanical ventilation, 13.4% developed AKI, 4% required dialysis, and 4.3% presented cardiac arrhythmia. Comorbidities included COPD (in 6%), diabetes (in 36.6%), hypertension (in 61.5%), and cardiovascular disease (in 17%). Seven patients presented moderately high levels of Mg (> 4.0 mg/dL), and all of those patients died. Of the 344 HyperMg group patients, 97 (28%) had hypernatremia and 27 (8%) had hyponatremia. HypoMg was found in 166 (5.2%) of the patients (84 men and 82 women). The mean age of the HypoMg group patients was 59.0 +/- 1.4 years (range, 18-99 years), and 23% died during hospitalization. Of the 166 HypoMg group patients, 11 (6.6%) had hypernatremia and 11 (6.6%) had hyponatremia. Conclusion(s): Magnesium disturbances, especially HyperMg, appear to be common in COVID 19, increasing the risk of death. Further studies are needed in order to determine the cause of the high rate of hypermagnesemia in patients with COVID-19.
ABSTRACT
Background: There are no objective criteria for the discontinuation of renal replacement therapy (RRT) in patients who have acute kidney injury (AKI). It is unknown if Kinetic Estimated Glomerular Filtration Rate (KeGFR) can be used as assessment of renal recovery in patients who underwent RRT. Methods: All critical patients in Hospital das Clínicas during September 2020 to May 2021 who started hemodialysis due to AKI and remained free of RRT for at least 2 consecutive days were included. Patients who stopped RRT due to decision for exclusive palliative care or hemodynamic instability were excluded. Patients were divided in two groups: Success group (free from RRT for 7 consecutive days after their last RRT session) and failure group. Discontinuation day was defined as the second day without RRT. Variables were expressed as median (25th and 75th percentile) and categorical data as percentage. Mann Whitney test was used. Statistical significance was defined as p<0.05. Results: 72 patients were enrolled. COVID19, ischemia-reperfusion and sepsis were the main causes of AKI (37%;28,7%;24,6%, respectively), with no difference in prevalence between groups. Success group (n=47) presented higher KeFGR on the day of discontinuation (keGFR1) and in the day after (keGFR2) when compared to failure group (n=25): KeGFR1: Success: 18.76ml/min vs. failure: 10.21ml/min, p=0.05. KeGFR2: Success: 29.38ml/min vs. failure: 16.03ml/min, p<0.05. Success group had lower non renal SOFA score at discontinuation (4 vs. 6;p<0.05) and higher urine output (1600 vs. 725;p<0.05) when compared to failure group. There was no difference in diuretic use. Conclusions: KeGFR is higher in patients who succeed in stopping RRT and it may be an useful tool for decision-making. Supported by FAPESP.
ABSTRACT
Background: In COVID-19, as in SARS, the degree of kidney injury can have major implications for the clinical outcomes. Early reports indicate that, among patients with COVID-19, AKI is common and is associated with worse outcomes. However, COVID-19-related AKI among ICU patients in Brazil has not been well described. Methods: This was a retrospective observational study of the electronic health records of patients with COVID-19-related AKI admitted to the Hospital das Clínicas in the city of São Paulo, Brazil, between March and August of 2020. We applied only KDIGO criteria 2 and 3. We used logistic regression to analyze risk factors for the composite outcome of mortality or RRT. Results: Among the 694 patients with COVID-19-related AKI, the mean age was 63 years and mortality was 66.4%;41% needed vasoactive drugs, 66% needed mechanical ventilation, and 72% needed dialysis. Univariate analysis showed the following risk factors for mortality and RRT at admission: male sex;diabetes;CKD;vasoactive drug use;mechanical ventilation;acidemia;elevated lactate, magnesium, potassium, creatinine, C-reactive protein, creatine phosphokinase, total bilirrubin;proteinuria;hematuria;and increased fractional excretion of potassium (n=98) and sodium (n=110). The factors that remained significant in the multivariate analysis were male sex, vasoactive drug use, serum magnesium >2.5 mg/dL and oliguria (24-h urine output <500 mL). Conclusions: In ICU patients with COVID-19-related AKI, in Brazil and elsewhere, in-hospital mortality is high. The exact mechanism by which hypermagnesemia increases mortality in such patients merits further study.