tetano
Editor, Senior Moderator
Ann Intensive Care
. 2022 Dec 28;12(1):118.
doi: 10.1186/s13613-022-01094-6.
Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort
Nuttha Lumlertgul[SUP] 1 2 3 [/SUP], Eleanor Baker[SUP] 1 [/SUP], Emma Pearson[SUP] 1 [/SUP], Kathryn V Dalrymple[SUP] 4 [/SUP], Jacqueline Pan[SUP] 1 [/SUP], Anup Jheeta[SUP] 1 [/SUP], Kittisak Weerapolchai[SUP] 1 5 [/SUP], Yanzhong Wang[SUP] 4 [/SUP], Richard Leach[SUP] 1 [/SUP], Nicholas A Barrett[SUP] 1 [/SUP], Marlies Ostermann[SUP] 6 [/SUP]
Affiliations
Abstract
Background: Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK).
Methods: This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared.
Results: A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001).
Conclusions: In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB.
Trial registration: NCT04445259.
Keywords: Acute kidney injury; COVID-19; Critically ill; Kidney replacement therapy; Wave.
. 2022 Dec 28;12(1):118.
doi: 10.1186/s13613-022-01094-6.
Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort
Nuttha Lumlertgul[SUP] 1 2 3 [/SUP], Eleanor Baker[SUP] 1 [/SUP], Emma Pearson[SUP] 1 [/SUP], Kathryn V Dalrymple[SUP] 4 [/SUP], Jacqueline Pan[SUP] 1 [/SUP], Anup Jheeta[SUP] 1 [/SUP], Kittisak Weerapolchai[SUP] 1 5 [/SUP], Yanzhong Wang[SUP] 4 [/SUP], Richard Leach[SUP] 1 [/SUP], Nicholas A Barrett[SUP] 1 [/SUP], Marlies Ostermann[SUP] 6 [/SUP]
Affiliations
- PMID: 36575315
- DOI: 10.1186/s13613-022-01094-6
Abstract
Background: Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK).
Methods: This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared.
Results: A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001).
Conclusions: In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB.
Trial registration: NCT04445259.
Keywords: Acute kidney injury; COVID-19; Critically ill; Kidney replacement therapy; Wave.