ACUTE KIDNEY INJURY AMONG COVID-19 POSITIVE PATIENTS IS ASSOCIATED WITH HIGHER MORTALITY: SINGLE CENTER EXPERIENCE

ABSTRACT

BACKGROUND AND AIMS: Despite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome. METHOD: This retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368). RESULTS: Most of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P < .05). Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P < .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P < .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%);also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P < .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups. We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%). CONCLUSION: The prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.