ABSTRACT
INTRODUCTION: While COVID19 was initially thought to only affect the lungs, the virus also affects other organs including the kidneys. This has led to reports of renal function alterations including impairment and enhancement. The incidence of acute kidney injury (AKI) and augmented renal clearance (ARC) has been reported to be 25-35% and 25-75%, respectively. Several risk factors for AKI and ARC have been reported with many overlapping. This study sought to identify which patients might experience AKI vs ARC. METHOD(S): Hospitalized, adult patients with laboratory confirmed COVID19 from the National COVID Cohort Collaborative (N3C) database were included in this retrospective study. Patients who had all data to calculate creatinine clearance (CrCl) via Cockroft-Gault were screened and excluded for pregnancy, body mass index < 18kg/m2, history of end-stage renal disease on dialysis or nephrectomy, or lacking data to determine exclusion criteria. AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Potential demographic and biomarker predictors of AKI or ARC were considered in univariate and multivariate logistic regression models. RESULT(S): 11,274 patients were included in univariate and multivariate logistic regression analysis. 20.1% developed AKI and 34.2% experienced ARC. Significant variables associated with AKI included age, weight, height, white race, male sex, Hispanic ethnicity, and diabetes (OR 0.996, 1.01, 0.73, 0.969, 1.1, 1.11, and 1.06, respectively). Age, weight, black race, male sex, Hispanic ethnicity, and hypertension were all associated with experiencing ARC (OR 0.973 1.01, 0.753, 0.945, 1.15, 0.911, respectively). No biomarker variables were available from N3C database. CONCLUSION(S): While a significant proportion of patients with COVID19 experience alterations in renal function, there are many overlapping risk factors for the development of AKI or ARC including age, weight, and Hispanic ethnicity, with male sex as the only differentiating patients at risk for AKI vs ARC. Thus, determining which patient may be at risk for renal dysfunction or enhancement based on their demographic is still unknown. Further investigation is needed to identify patients who are at risk for each of these renal function alterations.
ABSTRACT
Introduction: COVID19 was originally thought to be solely a respiratory disease, however, other organs, such as the kidneys, are often also affected. While acute kidney injury (AKI) and augmented renal clearance (ARC) have both been documented, the incidence, renal characteristics, and outcome of each derangement have not been fully elucidated. Research Question or Hypothesis: What are the incidences, characteristics, and outcomes of AKI, ARC, and no AKI/ARC in patients hospitalized with COVID19? Study Design: Retrospective, observational cohort study Methods: Inpatient data from the National COVID Cohort Collaborative database with laboratory confirmed COVID19 who were >18 years old were utilized. Patients who had all data to calculate creatinine clearance (CrCl) via Cockcroft-Gault equation were screened. Exclusion criteria were pregnancy, body mass index <18kg/m2, history of end-stage renal disease on dialysis or nephrectomy. Episodes of AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Renal function characteristics and outcomes included days with episode, hospital length of stay (LOS), and mortality. Descriptive statistics and Mann-Whitney U tests were used for statistical analysis where appropriate with p<0.05 indicating statistical significance. Result(s): 15,608 patients from 11 sites were included. Overall, 57.3% were male with median age 62.7[50.1-73.2] years. The incidence of No AKI/ARC, AKI, and ARC was 43.5%, 22.9%, and 33.6%, respectively. Episodes of ARC lasted longer than AKI (4[2-7] vs 3[1-6] days;p<0.0001) Patients with AKI and ARC both had longer LOS compared to no AKI/ARC (19[10-34] and 6[4-11] vs 6[4-10];p<0.001). Patients with AKI had the highest mortality followed by no AKI/ARC then ARC (41.7% vs 10.1% vs 5.4%;p<0.001). Conclusion(s): A significant proportion of patients with COVID19 exhibit altered renal function throughout hospitalization. Clinicians should be mindful of these alterations given their associations with increased LOS and mortality with AKI. Future research should explore the impact of ARC on medication therapy in patients with COVID19.
ABSTRACT
INTRODUCTION: Patients infected with the novel SARSCoV- 2 virus may progress to develop acute respiratory distress syndrome (ARDS). Neuromuscular blockade is often used in ARDS to assist with ventilator synchrony, improve oxygenation, and facilitate prone positioning. Current guidelines recommend that neuromuscular blockade may be used in patients with COVID-19 and ARDS. Our study aimed to investigate differences in cisatracurium dosing requirements for ARDS in COVID-19 versus non-COVID-19 patients. METHODS: We conducted a retrospective cohort analysis of adult patients who received continuous infusion cisatracurium for ARDS or hypoxia from January 2020 to May 2020. Exclusion criteria included patients receiving cisatracurium continuous infusion <24 hours or who were also administered another neuromuscular blocking agent other than cisatracurium. The primary outcome was total dose of cisatracurium in COVID-19 versus non-COVID-19 patients. Secondary outcomes included total duration of cisatracurium infusion and total number of separate infusions. RESULTS: 107 patients were included;72.9% (n=78) had COVID-19 and 27.1% (n=29) did not. Non-COVID-19 patients were significantly younger (p<0.001) than COVID-19 patients with a mean age of 44.1 (SD ±14.2) versus 57.3 (SD ±14.5). Other baseline characteristics were similar between the groups. The median PaO2/FiO2 ratio was not different between the groups (p=0.563) with a median overall value of 68 (interquartile range [IQR] 60.1, 83.1). There was no difference in SOFA scores (p=0.063) with a mean overall score of 9.6 (SD ±3.1). There was no difference in the primary outcome of total dose of cisatracurium with a mean of 20.6 mg/hour (SD ±8.7) versus 21.6 mg/hour (SD ±11) between COVID-19 and non-COVID-19 patients (p=0.637). No difference was found after comparing weight-adjusted total dose between groups (p=0.113). The total duration of the infusion was similar with a median duration of 4 days (IQR 2.5, 7.5) in COVID-19 patients versus 3.7 days (IQR 2.3, 7) in non-COVID-19 patients (p=0.747). CONCLUSIONS: Dosing and duration of cisatracurium infusion was found to be similar for treatment of ARDS in COVID-19 and non-COVID-19 patients in this study. Further evaluation of the benefit and utilization of cisatracurium in the treatment of COVID-19 ARDS is warranted.