Enhanced personal protective equipment can cause acute kidney injury in health care workers during COVID-19 pandemics

ABSTRACT

Introduction: Enhanced personal protective equipment (PPE) can expose health care workers (HCWs) to high heat stress and dehydration. The objective of this study was to assess the risk of acute kidney injury (AKI) among HCWs during the pandemic. Material and Methods: We recruited 52 HCWs worked on the mobile COVID-19 screening bus in the summer of 2021. We measured the body water content, pulse, core body temperature, blood pressure, creatinine, and urinary analysis before and after the work shift. We obtained the amount of water intake, environmental and personal measurements of temperature, humidity, and heat stress index during the work shift. Physicians interviewed the study subjects to confirm their medical history. Paired sample t-tests were used to test the pre and post-measurements. Results and Conclusions: After excluding 18 subjects who did not wear PPE in the pilot study, 34 HCWs were used in the analyses (male 11.8%;female 88.2 %). Most of them were nurses, with a mean age of 30.53 years old (SD 6.82). After a work shift, 14.7% of the subjects had incident AKI (1.5 times reference value or increase≧0.3 mg/dl). Core body temperature increased 0.27 degree (95% confidence interval [CI] 0.16 to 0.38), creatinine level increased 0.161 mg/dl (95% CI 0.11 to 0.22, p<0.001). The estimated glomerular filtration rate (eGFR) showed a significant decline in renal function (-16.82 ml/min/1.73m2, 95% CI -22.47 to -11.17, p<0.001). There was a protective effect of hydration (p= 0.09). In conclusion, wearing enhanced PPE can cause kidney injuries. There is an urgent need to develop regulations to prevent AKI among HCWs.