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1.
Journal of Laboratory and Precision Medicine ; 7, 2022.
Article in English | Scopus | ID: covidwho-2026150

ABSTRACT

Background and Objective: Various tubular markers have been established for the diagnosis of kidney diseases and evaluation of treatment efficacy. Currently, there are limited treatments available for advanced kidney disease. Therefore, early identification of patients at high risk of progression to end-stage renal disease (ESRD) is necessary for the provision of appropriate treatment at an early phase. The present review focuses on newly established urinary tubular markers, i.e., urinary [tissue inhibitor of metalloproteinases-2 (TIMP-2)]*[insulin-like growth factor binding protein-7 (IGFBP7)] and L-type fatty acid binding protein (L-FABP). Methods: A literature search of the electronic databases MEDLINE (January 2014 to February 2022) was conducted using search terms of “urinary [TIMP-2]*[IGFBP7]”, “urinary L-FABP”, “kidney disease”, and “COVID-19”. Original articles, which were written in English and show clinical usefulness of urinary [TIMP-2]*[IGFBP7] or urinary L-FABP, were mainly reviewed. Key Content and Findings: These proteins are expressed in human tubules and are reported to have renoprotective functions against kidney disease. In 2014, the U.S. Food and Drug Administration approved the clinical application of NephroCheck, measuring urinary [TIMP-2]*[IGFBP7], for the diagnosis of acute kidney injury (AKI). Notably, the usefulness of urinary L-FABP in AKI, chronic kidney disease (CKD), diabetic kidney disease, aging, and coronavirus disease 2019 (COVID-19) has been widely reported. Furthermore, various methods have been established for the easy, rapid, and highly sensitive measurements of c in various situations. In 2011, urinary L-FABP was approved by the Ministry of Health, Labor and Welfare in Japan. Conclusions: Early utilization of an accurate marker may improve the prognosis of kidney disease and patient survival. © Journal of Laboratory and Precision Medicine. All rights reserved.

2.
Journal of Iranian Medical Council ; 5(1):131-139, 2022.
Article in English | Scopus | ID: covidwho-2025961

ABSTRACT

Background: Kidney transplant recipients are among vulnerable individuals with increased risk of developing COVID-19. Long-term immunosuppression and multiple co-morbidities might affect clinical characteristics of COVID-19 in such patients. In this study, we describe clinical presentations and the incidence of Acute Kidney Injury (AKI) in 9 kidney transplant patients with COVID-19. Methods: This retrospective case series was conducted on 9 kidney transplant recipients with COVID-19 who were admitted in Imam Khomeini Hospital Complex during the first wave of the disease in Iran from February 20 to 20th April 2020. The diagnosis of COVID-19 infection was confirmed by either positive results of quantitative RT-PCR on nasopharyngeal swabs or typical findings in chest CT scanning. Results: The median age of patients was 51 years and the graft was functional in all cases before COVID-19 infection. Most patients complained of fever (8 cases), followed by cough (7 cases) and shortness of breath (5 cases). Eight cases had lymphopenia, and leukopenia was reported in 4 cases. AKI occurred in 8 cases. The increase in serum creatinine level resolved partially in most cases, but those who required renal replacement therapy had worse prognosis. Those who survived the acute illness are still alive after more than 16 months with functioning graft. Conclusion: It was shown in our study that similar to general population, fever and respiratory symptoms are presenting features of COVID-19 in kidney transplant recipients. Lymphopenia is more prominent and the course of COVID-19 infection is more likely to be complicated by AKI in such patients. Copyright 2022, Journal of Iranian Medical Council. All rights reserved.

3.
Russian Journal of Anesthesiology and Reanimatology /Anesteziologiya i Reanimatologiya ; 2022(4):40-47, 2022.
Article in Russian | Scopus | ID: covidwho-2025837

ABSTRACT

Objective. To analyze the experience of renal replacement therapy (RRT) and blood purification (BP) methods in Moscow hospitals in the first months of a new coronavirus infection SARS-CoV2 (COVID-19). Material and methods. We analyzed survey data on the use of RRT and BP procedures in ICU patients with COVID-19 between March 15, 2020 and August 01, 2020. Data were obtained from 30 hospitals. Results. COVID-19 pandemic led to significant mortality (80.8%) in ICU patients requiring RRT and BP. Dead patients were older than survivors (66.0 (57.0;74.0) and 57.0 (44.5;65.0) years, respectively, p=0.000), they received interleukin blockers and JAK ki-nase inhibitors less often (19.3% and 27.7%, respectively, p=0.027). Survivors received earlier RRT after admission to ICU (2 (1.0;5.0) vs. 4 (1.0;7.0) days, p=0.008). In these patients, RRT was often administered before mechanical ventilation (46% and 21.9%, respectively, p=0.000). In survivors, RRT was more often used for extrarenal indications (23.8% and 12.6%, respectively, p=0.001) and for CKD (24.6% and 13.3%, respectively, p=0.001), less often for AKI stage 3 (31.7% and 47.8%, respectively, p=0.001). Survivors had lower serum creatinine by 33.4% (p=0.002), SOFA score by 33.4% (p=0.000) and procalcitonin by 65% (p=0.019) before RRT compared to dead patients. In survivors, methods of apheresis (11.3% and 3.4%, respectively, p=0.005) and selective hemoadsorption of cytokines were more common (14.9% and 5.1%, respectively, p=0.000), duration of hemoperfusion procedures was higher by 11.2% (p=0.015). Conclusion. Literature and our own data indicate advisability of renal replacement therapy for AKI stage 2—3 and multiple organ failure stage 2. Delayed decision-making in critically ill patients may be accompanied by higher mortality rate. © 2022, Media Sphera Publishing Group. All rights reserved.

4.
Genome Med ; 14(1):103, 2022.
Article in English | PubMed | ID: covidwho-2021328

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) occurs frequently in critically ill patients and is associated with adverse outcomes. Cellular mechanisms underlying AKI and kidney cell responses to injury remain incompletely understood. METHODS: We performed single-nuclei transcriptomics, bulk transcriptomics, molecular imaging studies, and conventional histology on kidney tissues from 8 individuals with severe AKI (stage 2 or 3 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria). Specimens were obtained within 1-2 h after individuals had succumbed to critical illness associated with respiratory infections, with 4 of 8 individuals diagnosed with COVID-19. Control kidney tissues were obtained post-mortem or after nephrectomy from individuals without AKI. RESULTS: High-depth single cell-resolved gene expression data of human kidneys affected by AKI revealed enrichment of novel injury-associated cell states within the major cell types of the tubular epithelium, in particular in proximal tubules, thick ascending limbs, and distal convoluted tubules. Four distinct, hierarchically interconnected injured cell states were distinguishable and characterized by transcriptome patterns associated with oxidative stress, hypoxia, interferon response, and epithelial-to-mesenchymal transition, respectively. Transcriptome differences between individuals with AKI were driven primarily by the cell type-specific abundance of these four injury subtypes rather than by private molecular responses. AKI-associated changes in gene expression between individuals with and without COVID-19 were similar. CONCLUSIONS: The study provides an extensive resource of the cell type-specific transcriptomic responses associated with critical illness-associated AKI in humans, highlighting recurrent disease-associated signatures and inter-individual heterogeneity. Personalized molecular disease assessment in human AKI may foster the development of tailored therapies.

5.
Pharmacy (Basel) ; 10(4)2022 Jun 22.
Article in English | MEDLINE | ID: covidwho-2023996

ABSTRACT

Machine learning (ML) has been used to build high-performance prediction models in the past without considering race. African Americans (AA) are vulnerable to acute kidney injury (AKI) at a higher eGFR level than Caucasians. AKI increases mortality, length of hospital stays, and incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to establish an ML-based prediction model for the early identification of AKI in hospitalized AA patients by utilizing patient-specific factors in an ML algorithm to create a predictor tool. This is a single-center, retrospective chart review. We included participants 18 years or older and admitted to an urban academic medical center. Two hundred participants were included in the study. Our ML training set provided a result of 77% accuracy for the prediction of AKI given the attributes collected. For the test set, AKI was accurately predicted in 71% of participants. The clinical significance of this model can lead to great advancements in the care of AA patients and provide practitioners avenues to optimize their therapy of choice in AAs when given AKI risk ahead of time.

6.
J Intensive Care Med ; : 8850666221121734, 2022.
Article in English | Web of Science | ID: covidwho-2020862

ABSTRACT

OBJECTIVE: Endotoxin is a component of Gram-negative bacteria and can be measured in blood using the endotoxin activity assay (EAA). Endotoxin exposure initiates an inflammatory cascade that may contribute to organ dysfunction. Endotoxemia has been reported in previous viral pandemics and we investigated the extent of endotoxemia and its relationship to outcomes in critically ill patients with COVID-19. MATERIALS AND METHODS: We conducted a Prospective Cohort Study of 96 critically-ill COVID-19 patients admitted to the George Washington University Hospital ICU from 25 Mar-6 Jun 2020. EAA and inflammatory markers (ferritin, d dimer, IL-6, CRP) were measured on ICU admission and at the discretion of the clinical team. Clinical outcomes (mortality, LOS, need for renal replacement therapy (RRT), intubation) were measured. Statistical analysis was conducted using descriptive statistics and effect estimates with 95% confidence intervals. Comparisons were made using chi-square tests for categorical variables, and T-tests for continuous variables. RESULTS: A majority of patients (68.8%) had high EAA [>/= 0.60], levels seen in septic shock. Only 3 patients had positive bacterial cultures. EAA levels did not correlate with mortality, higher levels were associated with greater organ failure (cardiovascular, renal) and longer ICU LOS. Among 14 patients receiving RRT for severe AKI, one had EAA < 0.6 (p = 0.043). EAA levels did not directly correlate with other inflammatory markers. CONCLUSIONS: High levels of endotoxin activity were found in a majority of critically-ill COVID-19 patients admitted to the ICU and were associated with greater risk for cardiovascular and renal failure. Further investigation is needed to determine if endotoxin reducing strategies are useful in treating severe COVID-19 infection.

7.
J Nephrol ; 2022.
Article in English | Web of Science | ID: covidwho-2014624

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) is commonly seen in critically ill hospitalized patients with COVID-19 and its incidence reaches 60% in this setting. The aim of this work was to determine the prevalence, characteristics, risk factors and mortality of AKI in patients admitted to the intensive care unit (ICU) for COVID-19. PATIENTS AND METHODS: This observational retrospective case series was conducted between February 1, 2020 and December 31, 2020 at the ICU of the university hospital Mohammed VI of Oujda, Morocco. all COVID-19 patients hospitalized in the ICU with acute respiratory failure were included. AKI was defined and classified into three stages using the KDIGO criteria 2012. We excluded patients with end-stage kidney disease and those who were under 18 years old. RESULTS: Six hundred adult patients were included and 65.5% of them were men. Sixty patients had minimal lung damage (< 25%), 105 patients had mild lung damage (25-50%), 186 had severe lung damage (50-75%) and 193 patients had very severe lung damage (> 75%). A total of 210 patients (35%) developed AKI, of whom 78 (37.2%) had mild AKI (stage 1) and 132 (62.8%) severe AKI (stages 2 and 3). Patients in the severe and mild AKI groups had a higher rate of comorbidities, especially hypertension (mild AKI [46.2%] vs. severe AKI [36.4%] vs. no AKI [27.4%], p = 0.002) and diabetes (mild AKI [52.6%] vs. severe AKI [33.3%] vs. no AKI [26.4%], p < 0.001). During hospitalization, 23.3% of patients with AKI received kidney replacement therapy. In-hospital mortality was observed in 51.3% for mild AKI, 55.3% for severe AKI and 21% in patients who did not have AKI (p < 0.001). CONCLUSION: Our findings revealed that not only severe AKI, but also mild AKI was correlated to in-hospital mortality. Whatever the severity of the kidney impairment, it remains a major prognostic element.

8.
J Crit Care ; 71: 154103, 2022 Jun 28.
Article in English | MEDLINE | ID: covidwho-2015606

ABSTRACT

PURPOSE: Our goal was to describe clinical outcomes and explore the physiological interactions between acute kidney injury (AKI) and acute respiratory failure (ARF) in critically ill patients. MATERIALS AND METHODS: Data were retrieved from the SEA-AKI study, a multinational multicenter database of adult ICUs from Thailand, Laos, and Indonesia. AKI was defined using KDIGO criteria stage 2-3. ARF was defined by being mechanically ventilated. Patients were assigned into 6 patterns based on AKI and ARF sequence: "no AKI/ARF", "ARF alone", "AKI alone", "ARF first", "AKI first", and "Concurrent AKI-ARF". The primary outcome was in-hospital mortality of each pattern. RESULTS: A final cohort of 5468 patients were eligible for the analysis. The "Concurrent AKI-ARF" had the highest in-hospital mortality of 69.6%. The "AKI first" and the "ARF first" had in-hospital mortality of 54.4% and 53%, respectively. Among patients with single organ failure, in-hospital mortality was 14.6% and 31.5% in the "AKI alone" and the "ARF alone", accordingly. In-hospital mortality was 12.4% in patients without AKI and ARF. CONCLUSION: Critically ill patients with ARF and AKI are at higher risk of in-hospital death. Different patterns of AKI and ARF interaction result in unique clinical outcomes as well as risk factors.

9.
J Clin Anesth ; 82: 110933, 2022 Aug 04.
Article in English | MEDLINE | ID: covidwho-2015587

ABSTRACT

OBJECTIVE: This study evaluated postoperative AKI severity and its relation to short- and long-term patient outcomes. DESIGN: A retrospective, single-center cohort study of patients undergoing surgery from January 2015 to May 2020. SETTING: An urban, academic medical center. PATIENTS: Adult patients undergoing elective, non-cardiac surgery at our institution with a postoperative length of stay (LOS) of at least 24 h were included. Patients were included in 1-year mortality analysis if their procedure occurred prior to June 2019. INTERVENTIONS: None. MEASUREMENTS: Postoperative AKI was identified and staged using the Kidney Disease Improving Global Outcomes definitions. The outcomes analyzed were in-hospital mortality, LOS, total cost of the surgical hospitalization, and 1-year mortality. MAIN RESULTS: Of the 8887 patients studied, 648 (7.3%) had postoperative AKI. AKI was associated with severity-dependent increases in all outcomes studied. Patients with AKI had rates of in-hospital mortality of 2.0%, 3.8%, and 12.5% for stage 1, 2, and 3 AKI compared to 0.3% for patients without AKI. Mean total costs of the surgical hospitalization were $23,896 (SD $23,736) for patients without AKI compared to $33,042 (SD $27,115), $39,133 (SD $34,006), and $73,216 ($82,290) for patients with stage 1, 2, and 3 AKI, respectively. In the 6729 patients who met inclusion for 1-year mortality analysis, AKI was also associated with 1-year mortality rates of 13.9%, 19.4%, and 22.7% compared to 5.2% for patients without AKI. In multivariate models, stage 1 AKI patients still had a higher probability of 1-year mortality (OR 1.9, 95% CI 1.3-2.6, p < 0.001) in addition to $4391 of additional costs when compared to patients without AKI (95% CI $2498-$6285, p < 0.001). CONCLUSIONS: All stages of postoperative AKI were associated with increased LOS, surgical hospitalization costs, in-hospital mortality, and 1-year mortality. These findings suggest that patients with even a low-grade or stage 1 AKI are at higher risk for short- and long-term complications.

10.
Revista Medica del Instituto Mexicano del Seguro Social ; 60(5):548-555, 2022.
Article in Spanish | MEDLINE | ID: covidwho-2012177

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) has provoked one of the greatest health crises of our time, which is why risk stratification at the time of hospitalization is essential to identify in good time patients with high morbidity and mortality risk. Dysnatremia as an independent predictor of mortality in patients with COVID-19 has recently become relevant. Objective: To find out if there is an association of dysnatremia with 28-day mortality, and as secondary objectives, its association with hospital stay, invasive mechanical ventilation (IMV) requirement and presence of acute kidney injury (AKI) during hospital stay. Material and methods: Retrospective, descriptive and analytical cohort study. All consecutive patients of 16 years or older of any gender, admitted to a third level hospital from March 1, 2020 to March 2021, who have a diagnosis of COVID-19 with positive PCR were included. Results: The study included a total of 722 patients. The prevalence of dysnatremia was as follows: 18 patients presented hypernatremia (2.49%) and 153 hyponatremia (21.19%). The presence of hypernatremia once sodium was corrected for glucose was associated with higher mortality (p < 0.05, OR 3.446;95% CI 1.776-6.688), an increased probability of presenting AKI (p <0.05, OR 2.985;95% CI 1.718-5.184) and a greater requirement for IMV (p < 0.05, OR 1.945;95% CI 1.701-5.098). Conclusions: Hypernatremia was associated with higher mortality, higher risk of presenting AKI and the requirement for IMV during hospitalization.

11.
Future Virol ; 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2009819

ABSTRACT

A 56-year-old male admitted to the hospital for generalized weakness and fever. He was treated in hospital for 10 days due to COVID-19. He did not receive any immunosuppressive therapy during admission. One day after his discharge he experienced back pain and received analgesic therapy for 10 days. About one month later he experienced severe back pain and gross hematuria. He was admitted to hospital with acute kidney injury and new-onset lower extremity muscle weakness. His renal biopsy revealed IgA nephropathy and thoracic/cervical/lumbar-spine imaging showed an epidural abscess. This is a unique case report of a patient developing an epidural abscess and acute kidney injury together as a serious complication of COVID-19 infection.

13.
Cureus Journal of Medical Science ; 14(7), 2022.
Article in English | Web of Science | ID: covidwho-2006487

ABSTRACT

Acute kidney injury (AKI) has been seen in patients hospitalized with a SARS-CoV-2 (COVID-19) infection, but the pathophysiology of glomerular injury is not yet fully understood. We present a case of COVID-19-related "glomerular endotheliosis" in which a 51-year-old female with a 13-year history of class IV lupus nephritis was admitted for COVID-19 pneumonia. Her lupus nephritis had been in complete renal remission for the past 10 years with a baseline serum creatinine level of 1.3 mg/dL and no proteinuria. Her serological workup, including complement levels, was unremarkable. Due to the worsening renal function and persistent proteinuria, she underwent a kidney biopsy that revealed diffuse glomerular endothelial cell swelling, also known as glomerular endotheliosis. Her clinical course unfortunately deteriorated and she succumbed to acute respiratory distress syndrome. As circulating anti-angiogenic factors may contribute to the pathogenesis of endothelial dysfunction leading to glomerular endotheliosis, we propose that a similar circulating antiangiogenic factor may have been triggered by COVID-19 and played a role in our patient's progressive renal failure.

14.
Indian Journal of Critical Care Medicine ; 26:S13-S14, 2022.
Article in English | EMBASE | ID: covidwho-2006327

ABSTRACT

Aim and background: The coronavirus 19 (COVID-19) disease is an infectious disease responsible for the ongoing global pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first described in December 2019 in Wuhan, China. The major cause of mortality in COVID-19 is pulmonary complications and ARDS, but now acute kidney injury (AKI) is also seen to be a common complication, often associated with worse outcomes. Objective: We review the incidence and outcomes of AKI among patients with COVID-19 infection, admitted in ICU in a tertiary care hospital in a period of 3 months. Materials and methods: This retrospective, observational study involved a review of 36 patients with COVID-19 admitted in a tertiary care hospital, who developed AKI. We describe the incidence of AKI among patients admitted during that time period, the requirement of dialysis among them, need for mechanical ventilation and mortality rate among them as compared those without AKI. Results: Out of 234 patients hospitalised during this period, 14.9% developed AKI. 70% of patients had other risk factors like HTN, diabetes mellitus. In-hospital mortality was 30.5% among patients with AKI versus 8% among those without AKI. As per staging done according to AKIN Criteria, 15 patients belonged to stage 1, 15 patients to stage 2, and 3 patients to stage 3. Of them, a total of 6 patients had required haemodialysis. 14 patients needed invasive mechanical ventilation. Of survivors with AKI who were discharged, 30% had not recovered to baseline kidney function by the time of discharge. Conclusion: AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, 61% only survived with the recovery of kidney function by the time of discharge.

15.
Turkish J Nephrol ; 31(3): 230-236, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2006430

ABSTRACT

We sought to characterize the clinical profiles and outcomes of patients with coronavirus disease 2019 and comorbid kidney disease hospitalized at urban, Midwestern tertiary care hospital. Material and Methods: In this single-center observational study, we describe 205 patients with acute kidney injury (n=98), dialysis-dependent chronic kidney disease stage 5 (n=54), or kidney transplant (n=53), admitted during the first surge of the local pandemic from March 19 2020, to July 31 2021. Results: Most patients in the cohort were African American (acute kidney injury, 51%; dialysis-dependent chronic kidney disease stage 5, 82%; kidney transplant, 62%), and obesity was common (acute kidney injury, 53%; dialysis-dependent chronic kidney disease stage 5, 44%; kidney transplant 56%). Mechanical ventilation was required in 50% of the acute kidney injury, 22% of the dialysis-dependent chronic kidney disease stage 5, and 13% of the kidney transplant recipients. Nearly half of the acute kidney injury patients (46%) died and 49% required replacement therapy, while in-hospital mortality was 24% in the dialysis-dependent chronic kidney disease stage 5 patients and 9% in the kidney transplant recipients. Logistic regression analysis identified older age and patient group as leading correlates of mortality, with lower death risk in the kidney transplant (24%; odds ratio (OR), 0.17; 95% CI 0.06-0.47) and dialysis dependent chronic kidney disease stage 5 (9%; OR, 0.36; 95% CI 0.16-0.78) patients compared to acute kidney injury patients (46%). Obesity was associated with 5-fold increased mortality risk in the coronavirus disease 2019 patients with acute kidney injury (OR, 5.32; 95% CI 1.41-20.03) but not in dependent dialysis chronic kidney disease stage 5 and kidney transplant patients. Conclusion: During the first surge of the pandemic, kidney patients hospitalized COVID-19 experienced high mortality, especially those with acute kidney injury, older age and obesity. Identifying those at highest risk for adverse outcomes may direct preventative strategies including counseling on vaccination.

16.
J Thorac Cardiovasc Surg ; 2022.
Article in English | PubMed | ID: covidwho-2000583

ABSTRACT

For yet another year, our lives have been dominated by a pandemic. This year in review, we feature an expert panel opinion regarding extracorporeal support in the context of COVID-19, challenging previously held standards. We also feature survey results assessing the impact of the pandemic on cardiac surgical volume. Furthermore, we focus on a single center experience that evaluated the use of pulmonary artery catheters and the comparison of transfusion strategies in the Restrictive and Liberal Transfusion Strategies in Patients With Acute Myocardial Infarction (REALITY) trial. Additionally, we address the impact of acute kidney injury on cardiac surgery and highlight the controversy regarding the choice of fluid resuscitation. We close with an evaluation of dysphagia in cardiac surgery and the impact of prehabilitation to optimize surgical outcomes.

17.
Perm J ; : 1-7, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1994486

ABSTRACT

Introduction Acute kidney injury (AKI) occurs in up to 10%-30% of coronavirus disease 2019 (COVID-19) patients. AKI patients who require renal replacement therapy (RRT) often have concurrent respiratory failure and represent a high-mortality-risk population. The authors sought to describe outcomes in hospitalized COVID-19 patients with AKI requiring RRT and determine factors associated with poor outcomes. Methods A retrospective cohort study of hospitalized COVID-19 patients with AKI requiring RRT during the period from March 14, 2020, to September 30, 2020, was performed at Kaiser Permanente Southern California. RRT was defined as conventional hemodialysis and/or continuous renal replacement therapy. The primary outcome was hospitalization mortality, and secondary outcomes were mechanical ventilation, vasopressor support, and dialysis dependence among discharged patients. Hospitalization mortality risk ratios were estimated up to 30 days from RRT initiation. Results A total of 167 hospitalized COVID-19 patients were identified with AKI requiring RRT. The study population had a mean age of 60.7 years and included 71.3% male patients and 60.5% Hispanic patients. Overall, 114 (68.3%) patients died during their hospitalization. Among patients with baseline estimated glomerular filtration rate (eGFR) values of ≥ 60, 30-59, and < 30 mL/min, the mortality rates were 76.8%, 78.1%, and 50.0%, respectively. Among the 53 patients who survived to hospital discharge, 29 (54.7%) continued to require RRT. Compared to patients with eGFR < 30 mL/min, the adjusted 30-day hospitalization mortality risk ratios (95% CI) were 1.38 (0.90-2.12) and 1.54 (1.06-2.25) for eGFR values of 30-59 and ≥ 60, respectively. Conclusion Among a diverse cohort of hospitalized COVID-19 patients with AKI requiring RRT, survival to discharge was low. Greater mortality was observed among patients with higher baseline kidney function. Most of the patients discharged alive continued to be dialysis-dependent.

18.
Niger J Clin Pract ; 25(8): 1348-1356, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1994308

ABSTRACT

Background: It has been reported that the most affected organ by the coronavirus disease 2019 (COVID-19) is the lung, closely followed by the kidney. Aim: Over the course of the COVID-19, the factors affecting mortality in acute kidney injury requiring renal replacement therapy (AKI-RRRT) have not been known. This study was conducted in order to shed light on this issue. Patients and Methods: There were 64 patients in total. Subjects were divided into two groups. Group 1 consisted of a control group that comprised 33 subjects who did not have AKI during the time in which they were infected with COVID-19. Group 2 was COVID-19 related AKI requiring renal replacement therapy (COVID-19 AKI-RRRT), which included 31 subjects who were exposed to AKI-RRRT. Results: In Group 2, 27 (87%) patients died and 4 (13%) patients were recovered. The predominance of comorbidity and presence of more than one additional disease (p < 0.05), the excessive number of inpatients in intensive care unit (ICU) (p < 0.05), high mortality rates (p < 0.05), advanced age (p < 0.05), and long hospitalization periods (p < 0.05) were evident in Group 2. Serum levels of variables such as white blood cells (WBC), neutrophils, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, glucose, lactate dehydrogenase (LDH), and prothrombin time (PT) were high for patients in the Group 2 (p < 0.05) group. However, serum levels of lymphocyte, hemoglobin (HGB), and albumin were low. Conclusions: It can be argued that COVID-19 AKI-RRRT is associated with higher mortality.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/therapy , Humans , Intensive Care Units , Kidney , Renal Replacement Therapy , Retrospective Studies , Risk Factors
19.
Indian J Nephrol ; 32(4): 348-358, 2022.
Article in English | MEDLINE | ID: covidwho-1988211

ABSTRACT

Introduction: There is a scarcity of information on the incidence and outcomes of acute kidney injury (AKI) in COVID-19 patients in India. Therefore, we analyzed the correlation of AKI risk factors, ventilatory support, and renal replacement therapy and compared the outcomes of first and second COVID-19 waves in this tertiary care center. Methods: We retrospectively analyzed the patients' medical records with a positive RT-PCR for COVID-19 between July 2020 and May 2021. We looked at the clinical outcomes of the first and second COVID-19 waves and documented the frequency, risk factors for AKI, and the relationship between AKI and in-hospital mortality. Univariate and multivariate binomial logistic regression yielded odds ratios for the risk variables of AKI. Risk differences and age-adjusted odds ratios, as well as 99.5% confidence intervals, were used to compare COVID-19 outcomes between the first and second waves. Results: Of the 1260 hospitalized patients with COVID-19, 86 (6.8%) presented with AKI and 8 (0.7%) patients required dialysis. The most common comorbidity was diabetes mellitus (55.2%), hypertension (42.1%), hypothyroidism (11.3%), and coronary artery disease (8.1%). A total of 229 (18.17%) patients were admitted to ICU, 574 (45.5%) received ventilation, and 26 (2.0%) required mechanical ventilation.The incidence of in-hospital death in the patients with AKI as per the stage from 1 to 3 was 9 (15.8%), 7 (35%), and 5 (55.6%), respectively.Compared to the first wave, the second wave cohort had a lower risk of AKI (adj OR: 0.426; CI: 0.232-0.782) and mortality (adj OR: 0.252; CI: 0.090-0.707). Conclusions: In our study, AKI prevalence was 6.8%, the need for ventilation was 45.5%, ECMO 0.2%, and the mortality rate 2.9%. Second wave of COVID-19 exhibits improved clinical outcomes compared to the first wave.

20.
Indian J Nephrol ; 32(4): 291-298, 2022.
Article in English | MEDLINE | ID: covidwho-1988206

ABSTRACT

Introduction: Acute kidney injury (AKI) can be a severe complication of the coronavirus 2019 (COVID-19) infection. Follow-up data of these AKI patients, including the rate of progression to chronic kidney disease (CKD), is limited. Methods: COVID-19 patients with AKI, admitted from June 1, 2020, to August 25, 2020, were enrolled prospectively. Their clinical profile, biochemical investigations, urine analysis, treatment, and outcome in terms of mortality or discharge were analyzed. The discharged patients were followed up 3 months later to determine their renal recovery status. Results: AKI was noted in 146 out of 4,613 COVID-19 patients with an incidence of 3.16%. The outcome was available for 111 patients. According to the KDIGO (Kidney Disease Improving Global Outcomes) AKI criteria, 20 (18%) patients were in Stage 1, 16 (14%) in Stage 2, and 75 (68%) in Stage 3 AKI. Proteinuria and hematuria were present in 66% and 41%, respectively. Renal replacement therapy (RRT) was required in 45 (40.5%) patients. A total of 53 (47.7%) patients turned RT-PCR negative and were discharged. The renal recovery at discharge was complete in 31 of 111 (28%), partial in 20 of 111 (18%), and none in two (2%) patients. At 3 months follow-up of discharged patients, total mortality rate was 55.85%. Twenty three of 53 (43%) recovered their renal functions to baseline and 26 of 53 (49%) had progressed to CKD. Diabetes mellitus, dyspnea, altered sensorium, severe acute respiratory distress syndrome, need for RRT, lymphopenia, high neutrophil-lymphocyte ratio, hyperglycemia, raised inflammatory markers, and hematuria were associated with high mortality rate and reached statistical significance. Conclusion: AKI in COVID-19 patients has a high mortality rate (55.85%) with a high CKD progression rate among survivors (49%).

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