ACUTE KINDEY INJURY OVER EXISTING CHRONIC KIDNEY DISEASE IN PATIENTS WITH SARS-CoV-2 INFECTION

ABSTRACT

Introduction: Patients with chronic kidney disease (CKD) and that have SARS-CoV-2 infection are at higher risk of developing acute kidney injury (AKI) and have higher mortality rates after hospital admission. Method(s) The study group included 120 patients 70 with a history of CKD (eGFR rate of <60 mL/min);and 50 were within the control group with no history of kidney disease. Data on patients' gender, age, co-morbidities, and laboratory results from blood and urine samples, taken at admission into the ER, were collected. Laboratory values included calculated eGFR (by the CKD-EPI 2021 formula), highly sensitive inflammatory markers, D-dimer, blood-cell counts, and changes in urine parameters (hematuria, proteinuria). Co-morbidities included hypertension, obesity, diabetes mellitus, vascular disease, and CKD. All patients had been treated by the official protocol of the Republic of Bulgaria for SARS-CoV-2 treatment, but not all of them have received remdesivir. We also assessed which risk factors may have led to AKI with emphasis to the levels of specific biomarkers (IL-6, IL-18, KIM-1, NGAL, ACE2, SAA). Result(s) Overall median age of patients was 65.7 years;gender ratio was 50% M/F in both groups. Median duration of symptoms before hospitalization was 6 days. Of the 120 patients, 35% were febrile with temperatures >38oC Overall, creatinine level on admission was elevated in 58.3% of cases;eGFR was <60 mL/min/1.73 m2 in 50% of patients. Mean value of eGFR on admission was 82.3 mL/min/1.73 m2 for the non-CKD group and 49.5 mL/min/1.73 m2 for the CKD group. In total, three patients needed renal-replacement therapy two patients from the CKD group and one from the non-CKD group. Urine samples showed 39 patients had proteinuria of these, 87.1% had 1+ proteinuria and the others had >1+. Of the 22 cases of hematuria, 54.5% had only 1+ hematuria. Acute kidney injury occurred in 38 patients (31.6%) of whom 31 had CKD (44.3% of CKD patients). Overall, within our cohort of 120 patients, in-hospital mortality was 19.1% (23 patients) of these, 66.6% had AKI (19 patients). Overall, 100% of patients that did not survive Covid-19 also had CKD. We also analyzed risk factors that may have led to AKI. Logistic regression for risk factors for AKI showed that, the factors significantly linked with the incidence of AKI were an eGFR of >=60 mL/min/1.73m2, having symptoms for >=6 or more days before hospitalization, and not having received remdesivir as a treatment. Also, the levels of IL-6, SAA, and KIM-1 were significantly higher for patients that had AKI. Conclusion(s) We found that CKD was not a risk factor for COVID-19-related AKI. Conversely, we found that developing AKI was significantly associated with in-hospitalization death, which was linked with renal inflammatory processes and injury caused by SARS-CoV-2. No conflict of interestCopyright © 2023