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VOLUME 26 , ISSUE 12 ( December, 2022 ) > List of Articles

Original Article

Evaluation of Predictors, Kinetics of Renal Recovery and Outcomes of COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study

Shiva Kumar Narayan, Alok Narasimha, Krithika Dandinashivara Muralidhara

Keywords : Acute kidney injury, Acute kidney injury recovery, Acute kidney injury relapse, Coronavirus disease-2019, Intensive care unit

Citation Information : Narayan SK, Narasimha A, Muralidhara KD. Evaluation of Predictors, Kinetics of Renal Recovery and Outcomes of COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2022; 26 (12):1293-1299.

DOI: 10.5005/jp-journals-10071-24372

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: The incidence of acute kidney injury (AKI) is greater than 50% among coronavirus disease-2019 (COVID-19) patients admitted to the intensive care unit (ICU). However, the literature on predictors and kinetics of renal recovery remains unclear. Patients and methods: This observational study was conducted in a 30-bedded mixed ICU of a tertiary care center from May 2020 to July 2021. A total of 200 consecutive adult COVID-19 patients who had AKI in ICU were included. Using logistic regression with the best subset selection, predictors of renal recovery were identified. Outcomes and kinetics of AKI recovery were determined. Results: Among 200 patients, 67 recovered from AKI, of which 38, 17, and 12 patients had transient AKI, persistent AKI, and acute kidney disease (AKD), respectively. A total of 25 patients had AKI relapse, primarily associated with hospital-acquired infections. Results of logistic regression showed that the combination of Acute Physiology and Chronic Health Evaluation (APACHE II) {odds ratio (OR) 1.1 [p < 0.001; 95% confidence interval (CI) 1.06–1.16]}, day onset of AKI [OR 1.6 (p = 0.001; 1.24–2.24)] and severity of AKI [OR 2.9 (p < 0.001; 2.03–4.36)] were the predictors associated with poor renal recovery. This model had sufficient discrimination with the area under the curve (AUC) of 0.86. Renal replacement therapy requirement and mortality among COVID–AKI patients were 68 and 84%, respectively. Conclusion: A higher APACHE II at admission, a longer time to onset of AKI, and the severity of AKI during ICU stay predicted poor renal recovery. Study results emphasize the need for stepping-up dialysis resources in the likely case of future waves of COVID-19. The relapse of AKI was associated with sepsis, and mortality rates were substantially high.


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  1. Munjal M, Das S, Chatterjee N, Setra AE, Govil D. Systemic involvement of novel coronavirus (COVID-19): A review of literature. Indian J Crit Care Med 2020;24(7):565–569. DOI: 10.5005/jp-journals-10071-23498.
  2. Nadim MK, Forni LG, Mehta RL, Connor MJ Jr, Liu KD, Ostermann M, et al. COVID-19-associated acute kidney injury: Consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol 2020;16(12):747–764. DOI: 10.1038/s41581-020-00356-5.
  3. Tendulkar P, Pandey P, Panda PK, Bhadoria AS, Kulshreshtha P. Descriptive epidemiology of COVID-19 deaths during the first wave of pandemic in India: A single-center experience. Indian J Crit Care Med 2022;26(1):71–75. DOI: 10.5005/jp-journals-10071-24085.
  4. Rodrigo E, Suberviola B, Santibáñez M, Belmar L, Castellanos Á, Heras M, et al. Association between recurrence of acute kidney injury and mortality in intensive care unit patients with severe sepsis. J Intensive Care 2017;5:28. DOI: 10.1186/s40560-017-0225-0.
  5. Palevsky PM. COVID-19 and AKI: Where do we stand? J Am Soc Nephrol 2021;32:1029–1032.
  6. Kellum JA, Sileanu FE, Bihorac A, Hoste EAJ, Chawla LS. Recovery after Acute Kidney Injury. Am J Respir Crit Care Med 2017;195(6):784–791. DOI: 10.1164/rccm.201604-0799OC.
  7. Forni LG, Darmon M, Ostermann M, Oudemans–van Straaten HM, Pettilä V, Prowle JR, et al. Renal recovery after acute kidney injury. Intensive Care Med 2017;43(6):855–866. DOI: 10.1007/s00134-017-4809-x.
  8. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury workgroup. KDIGO clinical practice guideline for acute kidney injury. Available at: https://experts.umn.edu/en/publications/kidney-disease-improving-global-outcomes-kdigo-acute-kidney-injur. Accessed on: 1 January 2022.
  9. Graversen HV, Jensen SK, Vestergaard SV, Heide–Jørgensen U, Christiansen CF. Defining baseline creatinine for identification of AKI in population-based laboratory databases: A Danish nationwide cohort study. Kidney 360 2022;3(2):232–241. DOI: 10.34067/KID.0006082021.
  10. Duff S, Murray PT. Defining early recovery of acute kidney injury. Clin J Am Soc Nephrol 2020;15(9):1358–1360. DOI: 10.2215/CJN.13381019.
  11. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centre, retrospective, observational study. Lancet Respir Med 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5.
  12. Yu Y, Xu D, Fu S, Zhang J, Yang X, Xu L, et al. Patients with COVID-19 in 19 ICUs in Wuhan, China: A cross-sectional study. Crit Care Lond Engl 2020;24(1):219. DOI: 10.1186/s13054-020-02939-x.
  13. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA 2020;323(16):1612–1614. DOI: 10.1001/jama.2020.4326.
  14. Koeze J, Keus F, Dieperink W, van der Horst IC, Zijlstra JG, van Meurs M. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol 2017;18(1):70. DOI: 10.1186/s12882-017-0487-8.
  15. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013;2013:479730. DOI: 10.1155/2013/479730.
  16. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol 2021;32(1): 151–160. DOI: 10.1681/ASN.2020050615.
  17. Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, et al. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis 2021;77(2):204–215. DOI: 10.1053/j.ajkd.2020.09.002.
  18. Pandit RA, Gagana BN, Vaity C, Mulakavalupil B, Choudhary JS, Jain V, et al. Clinical Characteristics and outcomes of COVID-19 patients hospitalized in intensive care unit. Indian J Crit Care Med 2021;25(9):992. DOI: 10.5005/jp-journals-10071-23945.
  19. Wiersema R, Eck RJ, Haapio M, Koeze J, Poukkanen M, Keus F, et al. Burden of acute kidney injury and 90-day mortality in critically ill patients. BMC Nephrol 2019;21(1):1. DOI: 10.1186/s12882-019-1645-y.
  20. Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr 2020;14(3):247–250. DOI: 10.1016/j.dsx.2020.03.013.
  21. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005;294(7):813–818. DOI: 10.1001/jama.294.7.813.
  22. Chen YT, Shao SC, Lai EC, Hung MJ, Chen YC. The mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: A systematic review and meta-analysis. Crit Care 2020;24(1):439. DOI: 10.1186/s13054-020-03134-8.
  23. Sharma P, Uppal NN, Wanchoo R, Shah HH, Yang Y, Parikh R, et al. COVID-19-associated kidney injury: A case series of kidney biopsy findings. J Am Soc Nephrol 2020;31(9):1948–1958. DOI: 10.1681/ASN.2020050699.
  24. Legrand M, Kellum JA. Serum creatinine in the critically ill patient with sepsis. JAMA 2018;320(22):2369–2370. DOI: 10.1001/jama.2018.16627.
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