ABSTRACT
BACKGROUND AND AIMS: Acute kidney injury (AKI) has been described as a frequent complication in patients with COVID-19. The incidence of AKI is estimated to be around 5%-80% depending on the series;however, data characterizing the type of AKI and the evolution of renal function parameters in the medium-long term are still limited. METHOD: Based on the initial AKI-COVID Registry, we developed an extended registry where we registered retrospectively new variables that included clinical and demographic characteristics, infection severity parameters and data related to AKI (ethology, KDIGO classification, need of renal replacement therapy, analytic values: baseline creatinine, maximum creatinine during admission, creatinine at discharge or death, creatinine at 1 month after hospitalization and urinary parameters). Recovery of kidney function was defined as difference in at discharge or posthospitalization creatinine < 0.3 mg/dL with respect basal creatinine. RESULTS: Our analysis included 196 patients: 74% male, mean age 66 + 13 years;65% hypertensive, 33% diabetic and 22% chronic kidney disease. According to the KDIGO classification: 66% AKI KDIGO3, 17% KDIGO2 and 15% KDIGO1. Creatinine values are summarized in Table 1. We found significant differences in the baseline/high creatinine differential;these differences were lost after hospitalization. The main types of AKI were prerenal (35%) and acute tubular necrosis secondary to sepsis (ATN) (53%). 89% of patients with ATN presented AKI KDIGO 3, compared with 57% in the prerenal group (P < .001). Patients with prerenal AKI had greater comorbidity. On the other hand, patients with ATN AKI developed more serious COVID-19 infection: higher percentage of severe pneumonia, admission to the intensive care unit and need for orotracheal intubation. The analytical parameters were more extreme in patients with ATN AKI, except for creatinine and urea upon admission, which were higher in the prerenal AKI group. A total of 89 patients died during the study;65% of ATN AKI patients versus 31% of prerenal-AKI patients (P < .001). The ATN was a mortality risk factor, whit a hazard ratio 2.74 [95% confidence interval (95% CI )1.29-5.7] (P = .008) compared with the prerenal AKI. CONCLUSION: AKI in hospitalized patients with COVID19 presented with two different clinical patterns. Prerenal AKI more frequently affected older, more comorbid patients, and with a mild COVID19 infection. The NTA AKI affected younger patients, with criteria of severity of infection and multiplying mortality almost three times. In analytical control 1-month post-hospitalization, most of the patients recovered their kidney function. Although the implications of AKI associated with COVID-19 in the development of chronic kidney disease are still unclear, our data suggest that most patients will recover kidney function in a medium term. (Table Presented).
ABSTRACT
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19. The incidence of AKI is estimated to be around 5%-80%, according to the series, but data on renal function evolution is limited. Our main objective was to describe the incidence of AKI in patients with SARS-CoV-2 infection;secondarily, we analysed the severity of AKI and medium-term renal function evolution in these patients. METHOD: A retrospective observational study that included patients hospitalized a single hospital, diagnosed with SARS-CoV-2 infection, who developed AKI (March- May 2020). We register clinical and demographic characteristics, creatinine upon admission and prior to discharge, as well as creatinine and CKD-EPI glomerular filtration rate (eGFR) after at least 3 months after discharge. CKD was defined according to KDIGO stages based on the eGFR (G3-G5). The KDIGO classification was used to define and classify AKI. Recovery of kidney function was defined as difference in at discharge or post-hospitalization creatinine < 0.3 mg/dL with respect basal creatinine. The clinical follow-up ranged from admission to death or end of study. RESULTS: Of 258 patients hospitalized with SARS-CoV-2 infection, AKI occurred in 73 (28.3%). 63% (n = 46) were men;the mean of age was 69 years (57-76). DRA severity: 35 (48%) KDIGO-1, 15 (21%) KDIGO-2 and 23 (31%) KDIGO-3. The mean stay was associated with the severity of AKI: 7 days (3-11) for KDIGO-1, 11 days for KDIGO-2 (5-22) and 12 days (8-35) for KDIGO-3 (P = .02). The stage of CKD established differences in the severity of AKI: 66.6% (n = 6) of the patients with CKD G4-G5 presented AKI-KDIGO 3 versus only 25.0% (n = 4) in the CKD-G3 patients (P = .02). Admission to the ICU was more frequent in KDIGO 2-3 versus KDIGO-1 [39% (n = 15) versus 9% (n = 3);P < .01]. Of the 48 patients discharged, 30 (62.5%) had recovered their baseline renal function upon discharge. Only 2 are still on RRT after 8 months (2.7% of all patients). Of the 25 patients died (34% of patients with AKI) with a median time of 3 days from DRA diagnosis (1-8). Renal function of 35 patients was monitored, which correspond to 19 (54%) KDIGO- 1, 8 (23%) KDIGO-2, 8 (23%) KDIGO-3 stages. In these patients, analytical control starting 3 months after hospitalization revealed FG 66 (SD 30;56-76) mL/min/1.73 m2. We have not found differences in renal function between pre- and posthospitalization in related test. A total of 77% (n = 37) of discharged patients recovered their baseline renal function in the post-hospitalization control. CONCLUSION: The incidence of AKI in the context of COVID-19 in our series was 28.3%, with an associated mortality of 34.2%. Most of the patients presented with AKI KDIGO 1 (47.9%). The severity of AKI is associated with a longer hospital stay, admission to the ICU and the requirement for RRT. The advanced stages of CKD preadmission showed more severity of AKI. The maintenance in TRS in our series has been 2.7%. Patients who were discharged for recovery/improvement of COVID-19 had normalized kidney function during subsequent follow-up, regardless of the severity of the AKI developed on admission for COVID-19. (Figure Presented).
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BACKGROUND AND AIMS: The incidence of acute renal failure (ARF) is frequent and has an implication in the morbidity and mortality of SARS-CoV-2 infection. METHOD: A retrospective descriptive study of patients admitted for SARS-CoV-2 infection during the first (G1) and second (G2) waves who presented with ARF. They correspond to the period from March to May 2020 (G1) and from August to December 2020 (G2). We compare populations, outcomes and treatments. RESULTS: A total of 73 patients in the first wave (G1), with a cumulative incidence (CI) of 28.3% (G1), compared with 58 patients in the second wave (G2), with a CI of 8% (G2). The mean age was higher in G2 [65.8 ± 15 years (G1);75.3 ± 14 (G2);P <.05], with no difference regarding sex [63% (G1);54% (G2)]. In G2, there was a higher proportion of patients with cardiovascular disease [23% (G1);57% (G2)], hypertension [56% (G1);83% (G2)]. The baseline glomerular filtration rate (GFR) being similar for both groups (CKD EPI: 69 mL/min/1.732 (G1);P = .27). In the first wave, the mean days from admission to ARF was 3.1 days ± 4.2, and 42% of the patients were diagnosed at admission (31 patients). In the second, it was 2.9 days ± 5.7, of which 60% at admission (35 patients). The most prevalent cause was prerenal in both. Higher proportion in G1 of KDIGO stage 3 (G1: 30% versus G2: 17%) and renal replacement therapy (RRT) (G1: 9 versusG2: 2 patients). Only 3 patients remained in RRT in G1 and 1 patient in G2. In G1, 64% recovered their GFR [mean time (MT): 7.5 ± 8 days], and the percentage of deaths was 34%. In G2, 72% recovered GFR (MT: 16 ± 25 days), and 19% of patients died. CONCLUSION: Despite a lower age and comorbidity of the first wave patients, the severity and lethality was higher. There were no differences in the proportion of patients who recovered their baseline renal function, although the recovery time was longer in the second wave. (Table Presented).
ABSTRACT
Quinoa has been cultivated for millennia in the Andes since its domestication on the shores of Lake Titicaca, between Peru and Bolivia. As a rustic crop of the Andean highlands, it has conquered the international market for less than thirty years. Today, Peru has become the world's leading producer and the majority of its production is exported. Produced locally by small-scale farmers and consumed globally, quinoa reflects the context of the globalization of agriculture and food. The COVID-19 crisis has also affected Peru and it raises questions about the robustness and resilience of export food chains. This opinion article looks back at debates organized in May-June 2020 in Peru. After recalling the general context of the cultivation of quinoa and the link between COVID-19, agriculture and biodiversity, we highlight the links between health crisis, agricultural crisis and food crisis. This global pandemic offers us the opportunity to question the current agricultural models to draw lessons to build the future. The projection of new solidarities through a collective trademark appears to carry a transnational territorial project at Andean level. Accompanying the actors to make it an inclusive development model requires adapted participatory tools.
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Introduction: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical-anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. Objectives: Describe the unit’s restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. Matherial and Methods: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an institutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. Results: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. Discussion: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health. © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.
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Background: SARS-CoV-2 coronavirus pandemic has significant impact on the general population, and chronic hemodialysis patients presented a poor prognosis with a mortality rate around 25%. Data from severe acute kidney injury(AKI) and acute renal replacement therapy(RRT) is scarce. We present the preliminary results of AKI COVID-19 Registry of the Spanish Society of Nephrology. Methods: The online Registry began operating on May 21th. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. Patients were diagnosed with SARS-Cov-2 infection based on PCR of the virus. Results: One week after the AKI COVID registry started, 54 patients with AKI with RRT and COVID-19 from 11 Hospitals. Age was 64+9years and 55% men. 65% hypertension, 31% diabetes mellitus, 14% cardiovascular disease, 26% chronic kidney disease, 6% neoplasm, 29% obesity, 8% chronic obstructive pulmonary disease, and6% smokers. Previous treatment: 10% immunosuppressive, 20% ACEi, 25% ARBs, 14% antiplatelets, and 10% anticoagulants. Clinical characteristics: 92% common respiratory symptoms, 96% pneumonia, 90% required intensive care unit(ICU) and 87% mechanic ventilation. 32% albuminuria, 18% hematuria, and 50% AKI with preserved urine output. Time from COVID-19 symptoms start to AKI 12.3+8days, time ICU 19.8+5days. APACHE at UCI admission 15+7. 81% lymphopenia. RRT was needed in 91% 13.4+12days: 55% received continuous RRT, and 72% anticoagulation. Kidney biopsy was not performed. Mortality 46.3% (60% males), and 4% remained under RRT. Time from AKI to renal function recovery 25+14 days. 65.2% death patients had hypertension. No differences were observed in comorbidities, chronic treatments, renal clinical characteristics, dialysis modality and mortality. Decreased lymphocyte count was associated with worse patient prognosis (dead 495±260 vs. survivors 789±460,p=0.023). Conclusions: The mortality in AKI with RRT and COVID-19 is alarming high. Severe AKI associated with COVID-19 disease is more frequent in males. Interestingly, half of the patients preserved urine output. Severe lymphopenia was associated with mortality. More data from the AKI COVID-19 registry will help us to enlighten the prognosis and risk factors associated to mortality.