tetano
Editor, Senior Moderator
BMJ Open
. 2025 May 6;15(5):e094887.
doi: 10.1136/bmjopen-2024-094887. Incidence of major adverse kidney events after ICU admission in COVID-19 and non-COVID-19 ARDS patients
Faraj K Alenezi[SUP] 1 2 3 [/SUP], Rahul Y Mahida[SUP] 3 [/SUP], Mansoor N Bangash[SUP] 4 [/SUP], Jaimin Patel[SUP] 3 [/SUP], David Thickett[SUP] 3 [/SUP], Dhruv Parekh[SUP] 5 [/SUP]
Affiliations
Objectives: To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes.
Design: Retrospective cohort study.
Setting: Single-centre intensive care unit in the Midlands, UK.
Participants: 708 ARDS patients (458 COVID-19, 250 non-COVID-19).
Primary and secondary outcome measures: The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) <75% of baseline or all-cause mortality. Secondary analyses examined non-mortality MAKE components.
Results: The incidence of MAKE-365 was significantly higher in the non-COVID-19 group compared with the COVID-19 group (66% vs 39%, p<0.001), primarily driven by increased RRT initiation, followed by mortality and eGFR decline (p=0.055). Independent predictors of MAKE-365 included lower eGFR and elevated bilirubin in both groups. Age (p<0.001) and diabetes (p=0.041) were additional predictors in the COVID-19 cohort, while lower albumin (p=0.002) was significant in the non-COVID-19 group. Excluding mortality, RRT and eGFR decline remained significant drivers of MAKE outcomes in the non-COVID-19 cohort.
Conclusions: Non-COVID-19 ARDS patients face a greater risk of MAKE-365 and adverse kidney outcomes due to higher RRT requirements and mortality rates. These findings underscore the importance of tailored interventions and long-term nephrology follow-up, particularly for patients with reduced eGFR, elevated bilirubin and comorbidities like diabetes and hypoalbuminaemia.
Keywords: Acute renal failure; COVID-19; INTENSIVE & CRITICAL CARE; Intensive Care Units; Respiratory Distress Syndrome.
. 2025 May 6;15(5):e094887.
doi: 10.1136/bmjopen-2024-094887. Incidence of major adverse kidney events after ICU admission in COVID-19 and non-COVID-19 ARDS patients
Faraj K Alenezi[SUP] 1 2 3 [/SUP], Rahul Y Mahida[SUP] 3 [/SUP], Mansoor N Bangash[SUP] 4 [/SUP], Jaimin Patel[SUP] 3 [/SUP], David Thickett[SUP] 3 [/SUP], Dhruv Parekh[SUP] 5 [/SUP]
Affiliations
- PMID: 40328653
- PMCID: PMC12056615
- DOI: 10.1136/bmjopen-2024-094887
Objectives: To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes.
Design: Retrospective cohort study.
Setting: Single-centre intensive care unit in the Midlands, UK.
Participants: 708 ARDS patients (458 COVID-19, 250 non-COVID-19).
Primary and secondary outcome measures: The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) <75% of baseline or all-cause mortality. Secondary analyses examined non-mortality MAKE components.
Results: The incidence of MAKE-365 was significantly higher in the non-COVID-19 group compared with the COVID-19 group (66% vs 39%, p<0.001), primarily driven by increased RRT initiation, followed by mortality and eGFR decline (p=0.055). Independent predictors of MAKE-365 included lower eGFR and elevated bilirubin in both groups. Age (p<0.001) and diabetes (p=0.041) were additional predictors in the COVID-19 cohort, while lower albumin (p=0.002) was significant in the non-COVID-19 group. Excluding mortality, RRT and eGFR decline remained significant drivers of MAKE outcomes in the non-COVID-19 cohort.
Conclusions: Non-COVID-19 ARDS patients face a greater risk of MAKE-365 and adverse kidney outcomes due to higher RRT requirements and mortality rates. These findings underscore the importance of tailored interventions and long-term nephrology follow-up, particularly for patients with reduced eGFR, elevated bilirubin and comorbidities like diabetes and hypoalbuminaemia.
Keywords: Acute renal failure; COVID-19; INTENSIVE & CRITICAL CARE; Intensive Care Units; Respiratory Distress Syndrome.