ABSTRACT
Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes.
ABSTRACT
Initial reports suggested that kidney involvement after coronavirus disease 19 (COVID-19) infection was uncommon, but this premise appears to be incorrect. Acute kidney injury can occur through various mechanisms and complicate the course of up to 25% of patients with COVID-19 hospitalized in our Institution, and of over 50% of those on invasive mechanical ventilation. Mechanisms of injury include direct kidney injury and predominantly tubular, although glomerular injury has been reported, and resulting from severe hypoxic respiratory failure, secondary infection, and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of progressive kidney damage and, in some cases, the use of renal replacement therapy. Although the use of blood purification techniques has been proposed as a potential treatment, results to date have not been conclusive. In this manuscript, the mechanisms of kidney injury by COVID-19, risk factors, and the mainstays of treatment are reviewed.
ABSTRACT
BACKGROUND AND AIMS AKI is a common complication in critically ill patients, during the COVID-19 pandemic, it has been presented directly associated with damage by the virus, due to the severity of the disease and secondary to treatment, that is, secondary to the crosstalk of organs and the crosstalk of support equipment, such as the extracorporeal oxygenation membrane (ECMO), which has been used in patients with severe respiratory failure. According to the international bibliography, the incidence of AKI in ECMO ranges from 26% to 85% depending on the characteristics of the patient, the percentage that requires KRT is around 45%. OBJECTIVE Our hospital is a national reference center for ECMO support therapy as for lung transplantation, it is the only center that has an active program, so understanding the epidemiology of AKI associated with ECMO in our population is important, in addition to representing a part of the experience in Latin America. METHOD Retrospective and descriptive studies were included all patients 18 years or older connected to ECMO with a diagnosis of severe pneumonia for COVID-19 from June 2020 to August 2021. Data were collected in Excel and using the ECMO Team platform data that is shared in the ELSO. Descriptive data analysis was performed with SPSS V21 and Excel. RESULTS A total of 48 patients were connected to ECMO for COVID-19 severe pneumonia in our center, of which 39 were men. Average age 49 years (min 21 year, max 68 year), average weight 93 kg (min 55 kg, max 125 kg) 25 patients (52%) with AKI, 22 (45%) required KRT and 100% CKRT. Of them, 10 patients (20%) have kidney recovery function, all of them get out form ECMO. From all, 45% patients died, these 45% were still in ECMO. In most of the cases, the AKI cause is multifactorial, but the most common cause identified was sepsis, the second nephrotoxicity (antibiotics like vancomycin and colistin) and the third hemolysis (an ECMO membrane complication). About the indication of star KRT: 50% fluid overload, 30% acidosis and uremia and 20% anuria. A total of 100% of patients were in ECMO-VV at time CKRT started, all were connected in parallel in ECMO in post-blood pump and return pre-blood pump, with no coagulation problems as long as they have the ECMO anticoagulation, 93% patients with heparin and 7% with argatroban for HIT suspicious. As data to highlight from our population, there is the first bilateral lung transplant secondary to COVID-19 in Latin America and the longest air transfer in ECMO in the world. CONCLUSION In our center, the AKI, KRT and mortality in patients with ECMO are much like other centers reported. In COVID-19, there is not yet very clear evidence and more studies should be done. This is the first study in Mexico about ECMO, AKI and COVID-19.