ABSTRACT
Background: Kidney damage in COVID-19 patients has been of special concern. Kidney function after COVID-19 has not been comprehensively studied, and there is scarce information comparing kidney function among patients with or without AKI during hospital admission. Method(s): Retrospective cohort study in a secondary level center in Guadalajara, Mexico. Patients who were admitted due to COVID-19 from April-December 2020 and who survived at discharge and who had at least one follow-up visit in the outpatient clinic 6 months after initial symptoms were included. Information was obtained from outpatient electronic medical files. Result(s): From a total of 1085 patients, 733 survived at discharge. 113 had AKI during admission and only 33 (29.2%) had any kind of outpatient follow-up. Their mean age was 60.6 years, 63.6% were men, 48.4% had DM and 66.6% had HTN. Mean baseline SCr was 0.82 mg/dL with a mean eGFR of 90.82 ml/min. On follow-up mean stable SCr increased to 1.49 mg/dL, with a mean eGFR of 65.71 ml/min, a mean decrease of 25.11 ml/min. 15 patients (45.45%) developed CKD and 1 patient (3.03%) started RRT. Mean follow-up time was 451 days. 34 patients with no AKI during admission had a follow-up visit;mean age was 58.1 years, 58.8% were men, 47.1% had DM and 70.6% had HTN. Mean baseline SCr was 0.78 mg/dL and mean eGFR was 92.33 ml/min. On follow-up mean stable SCr increased to 0.86 mg/dL, with a mean eGFR of 86.64 ml/min, a mean decrease of 5.69 ml/min. 1 patient (2.94%) developed CKD and none required to start RRT. Mean follow-up time was 468 days. Conclusion(s): AKI during COVID-19 was associated to a significant decrease in eGFR on follow-up. Those with COVID19 without AKI during admission also had a small decrease in eGFR on follow-u. Timely and more intense follow-up strategies after COVID19 and AKI are needed.
ABSTRACT
Background: Acute kidney injury (AKI) in COVID-19 is associated with disease severity. The aim of this study was to identify risk factors associated with the development of AKI and its clinical impact, such as need for RRT and mortality. Methods: Retrospective cohort study of hospitalized adult patients COVID-19, with normal kidney function, from April to December 2020 in Western Mexico. Results: 882 patients (60.8% men) with a mean age of 58.9y were included. 342 (38.8%) had a prior diagnosis DM, 412 (46.7%) HTN, 161 (18.3%) obesity, 59 (6.7%) heart diseases, 25 (2.8%) neurological disease, 47 (5.3%) lung disease. 216 (24.5%) smoking history. 270 patients (30.6%) developed AKI, 95 (10.77%) KDIGO stage 1, 44 (4.98%) stage 2, and 84 (9.52%) stage 3. 59 patients required RRT (6.23%), and 111 patients (12.6%) mechanical ventilation. Overall mortality was 30.6% (270 patients). Risk factors for mortality were: DM, HTN, neurological disease, age > 65 y, need for MV, and MAP < 65 mmHg, hyperNa, increased D-dimer or decreased HCO3 at admission. Risk factors for AKI were: DM, HTN, heart disease, age > 65 y, need for MV, and MAP < 65 mmHg, hyperNa, increased D-dimer or decreased HCO3 at admission. Image shows risk factors, ORs with CI. Conclusions: A high incidence of AKI in the Mexican population compared to reports from other countries, with a significantly high risk for death.
ABSTRACT
Background: COVID-19 is a new disease of pandemic proportions. Currently, there are no reports on clinical outcomes in patients with CKD with and without KRT in the Mexican population. Our aim was to describe the clinical outcomes in patients with CKD. Methods: Retrospective cohort study of hospitalized adult patients COVID-19 confirmed with RT-PCR, from April to December 2020 in a second-level hospital in Western Mexico. Information was obtained from medical records. Results: 1012 patients were included, of which 130 patients (12.8%) had CKD (65.3% men), with a mean age of 53.8 years, 43.8% with Diabetes Mellitus and 82.3% with Hypertension. 84 patients (64.6%) were on KRT, within which 47 patients were on hemodialysis, 31 on peritoneal dialysis and 6 with a kidney transplant. 46 patients had no KRT, in stages ranging from KDIGO 3b to 5. 78.4%. 14 patients (10.7%) required mechanical ventilation. In our study, mortality among patients with normal kidney function was 30.6%. Regarding patients with CKD, patients on hemodialysis had a mortality of 25.5% (OR 0.74, 95% CI 0.39-1.5), patients on peritoneal dialysis had a mortality of 54.8% (OR 2.75, 95% CI 1.33-5.66), patients with CKD and no KRT had a mortality of 43.5% (OR 1.74, 95% CI 1.15-3.17). Conclusions: In our population, an increased mortality was found in patients with CKD with and without KRT, highlighting the mortality of patients on PD.
ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) is a new disease of pandemic proportions. Currently, there are no reports about kidney involvement and the association with mortality in Mexico. Our aim was to describe the characteristics in our population, clinical and renal outcomes. Methods: Prospective, descriptive, single-center study in patients diagnosed with COVID-19 (positive RT-PCR tests), admitted to our hospital from April 2020 to date. Results: 48 patients (60.41% men) with an average age of 54.33 years were included. 23 (47.9%) had a previous diagnosis of HTN and DM, 11 (22.9%) had obesity, 5 (10.4%) had neurological diseases, 4 (6.3%) had heart disease, 3 (6.3%) had malignancies and 1 (2.1%) had liver disease. 9 (18.8%) patients with a history of smoking. At admission, the mean oxygen saturation was 85.76%. The main reason for consultation was dyspnea in 35 patients (72.9%). Regarding symptoms, 81.3% (39) had dyspnea, 87.5% (42) fever, 54.2% (26) headache, 72.9% (35) cough and, to a lesser extent, odynophagia, myalgia and malaise in 33.3% (16), 45.8% (22) and 41.7% (20) respectively. The mean creatinine, urea and bicarbonate was 1.34 mg/dl, 56.69 mg/dl, and 18.49 mmol/l respectively. 25% of the patients required ICU admission and 27.1% mechanical ventilation. During the study period, 19 patients (39.6%) developed AKI, 20.8% classified as KDIGO stage 1 and 18.8% as stage 3. At the end of this study, 56.3% (27) had a complete recovery, 35.4% (16) died and 8.3% (5) are still admitted. Regarding the patients that had an AKI, 6 (31.57%) had a complete recovery, 3 (15.7%) required intermittent HD but eventually died, for a total of 13 death patients (68.4%). There was a statistically significant difference in mortality between patients with AKI vs patients with normal kidney function (p=0.002), with a RR of 3.47. Conclusions: This study showed a higher prevalence of AKI in the Mexican population compared to reports from other countries, with a significantly higher risk for death. Special attention should be paid to this outcome and as nephrologists, we must take an active role in the care of these patients.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a new disease of pandemic proportions. There are only a few reports about urinary abnormalities in this disease, and to our knowledge there are no reports about the usefulness of urinary sediment on prognosis. Our aim was to describe the urinary abnormalities in COVID-19 and to assess the utility of urinary sediment on prognosis in COVID-19. Methods: Prospective, single-center study, in patients diagnosed with COVID-19 (with a positive RT-PCR test), who were admitted in our hospital, from April 2020 to date, and whose urine sample could be obtained at admission to the isolation wing. Results: 22 patients were included;17 (77.3%) had proteinuria, 12 (54.5%) had microscopic hematuria, and 9 (40.9%) had leukocyturia. Granular casts (with a Chawla cast scoring index greater than 3) were present in 8 (36.4%) patients. Of the 8 patients with granular cast, 6 developed an AKI (75%), 2 required Hemodialysis (25%) and 3 died (37.5%). Of the 14 patients whose urinary sediment was classified as bland, 5 developed an AKI (35.7%), none of them required hemodialysis, and 2 subsequently died (14.2%). There was a statistically significant difference between a bland urinary sediment and a sediment showing granular casts for the need of hemodialysis or death (p=0.02), with a positive LR of 3.5. Conclusions: The urinary sediment is a cheap, available tool for the prognosis of need for hemodialysis or death in patients diagnosed with COVID-19, and should be taken into consideration in the assessment of these patients by the Nephrology department.