Acute Kidney Injury in patients with Severe COVID-19 in Mexico

1. Acute kidney injury (AKI) was common among individuals in Mexico with COVID-19 pneumonia.

2. Risk factors for developing AKI were older age, obesity, and need for invasive mechanical ventilation upon admission.

Evidence Rating Level: 3 (Average)

Individuals testing positive for COVID-19 present with a wide range of comorbidities. COVID-19 pneumonia and its impact on acute kidney injury (AKI) may provide information related to the risks faced by this population and how COVID-19 may effect AKI progression. This retrospective cohort study reviewed medical records of individuals with severe COVID-19 pneumonia at a major institution in Mexico between March and April 2020. A total of 99 participants (M [SD] age = 52.9 [13.2] years, 25.3% female) were included in analyses, 58.6% of whom developed AKI. Several risk factors for AKI emerged: older age (OR = 1.07, 95% CI 1.01 to 1.13, p = .024), obesity (OR = 6.58, 95% CI 1.8 to 24.05, p = .040), and need for invasive mechanical ventilation (IMV; OR = 6.18, 95% CI 1.29 to 29.58, p = .023). Mortality-specific risk factors included AKI (OR = 8.61, 95% CI 2.24 to 33.1, p = .002), requirement of vasoactive drugs on admission (OR = 5.35, 95% CI 1.16 to 24.61, p = .031), and obesity (OR = 5.57, 95% CI 1.48 to 20.93, p = .011). Individuals with AKI stage 3 (79.3%) and stage 2 (68.7%) had greater odds of in-hospital mortality compared to those with stage 1 (25%; p = .004). This study went further and reviewed the 53 participants who underwent furosemide stress tests (FST) to predict AKI progression. A total of 12 (22%) progressed to AKI stage 3. The ROC curve for the FST proved to have predictive value related to progression (AUC = .681, p = .009; sensitivity = 81.6%, specificity = 54.5%). Overall, this study suggests that AKI is a common presentation among patients with COVID-19 pneumonia and that risk factors for AKI and its progression are obesity, older age, and the need for IMV on admission.

Click to read the study in PLOSONE

Image: PD

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