Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit

2021 ◽  
pp. 1-5
Author(s):  
Francesco Alessandri ◽  
Valentina Pistolesi ◽  
Chiara Manganelli ◽  
Franco Ruberto ◽  
Giancarlo Ceccarelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Icu Stay ◽  
Renal Function Recovery ◽  
Tertiary Teaching

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. <b><i>Methods:</i></b> From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay &#x3c;48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. <b><i>Results:</i></b> Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (<i>p</i> = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. <b><i>Conclusion:</i></b> In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P &lt; 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P &lt; 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine &gt;2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P &lt; 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

scholarly journals Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

2020 ◽  
Author(s):  
Nina J Caplin ◽  
Olga Zhdanova ◽  
Manish Tandon ◽  
Nathan Thompson ◽  
Dhwanil Patel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Acute Kidney Injury ◽  
New York City ◽  
Renal Function ◽  
Intensive Care ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Bellevue Hospital ◽  
Kidney Replacement Therapy

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy. Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position. In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

scholarly journals Prevention of acute kidney injury and protection of renal function in the intensive care unit

2009 ◽  
Vol 36 (3) ◽  
pp. 392-411 ◽  
Author(s):  
Michael Joannidis ◽  
Wilfred Druml ◽  
Lui G. Forni ◽  
A. B. Johan Groeneveld ◽  
Patrick Honore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury

scholarly journals Spectrum of acute kidney injury in intensive care unit: a single centre experience

2017 ◽  
Vol 69 (1) ◽  
pp. 44
Author(s):  
Suresh Kumar Sinha ◽  
Mukteshwar Rajak ◽  
Prabhakar . ◽  
Rajneesh . ◽  
Vivek Tripathi
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Kidney Injury ◽  
Final Outcome ◽  
Clinical Spectrum ◽  
Icu Stay ◽  
Organ System Failure ◽  
Apache Iv

<p><span class="ABS_Bold-Italic" lang="en-GB">Background</span><span class="ABS_Bold-Italic" lang="en-GB">:</span><span> Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to device methods to improve the final outcome due to this problem. </span></p><p><span class="ABS_Bold-Italic" lang="en-GB">Aims and Objectives:</span><span> The aim of present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of AKI in the setting of ICU. </span></p><p><span class="ABS_Bold-Italic" lang="en-GB">Materials and Methods:</span><span> This prospective study involved patients admitted to ICU during the period between June 09 to June 10. Patients who developed AKI during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded includes patients demographic profile, underlying clinical illness responsible for ICU admission, dialysis requirement, need for ventilation, total duration of ICU stay, acute physiology and chronic health evaluation (APACHE)-IV score and final outcome and these data were analyzed for predicting survival using univariate and multivariate analysis. </span></p><p><span class="ABS_Bold-Italic" lang="en-GB">Results:</span><span> 574 patients were admitted to ICU from June 09 to June 10 and (n = 124; 21.6%) patients developed AKI after admission to ICU. Mean age 44.87 ± 15.14 years and (n = 71; 57.1%) were males and (n = 53; 42.9%) were females. Out of 124 patients (50.80%; n = 63) had medical, (33.87% n = 42) had surgical and (15.32%; n = 19) had obstetric cause of admission in ICU. Of the 574 patients (12.02%; n = 69) had associated co morbidities, hypertension is the most common associated morbidities (4.7%; n = 27), others were diabetes mellitus (3.6%; n = 21), coronary artery disease (3.0%; n = 17), cerebrovascular disease (0.3%; n = 2), chronic obstructive pulmonary disease (0.3%; n = 2;). The etiology of AKI was multi-factorial, sepsis were the most common cause observed in (69.64%; n = 39), hypotension (67.84%; n = 38), volume depletion (19.64%; n = 11), nephrotoxic drugs (64.28%; n = 36) patients. Multi organ system failure (MOSF) was noted in (29.03%; n = 36) patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. </span></p><p><span class="ABS_Bold-Italic" lang="en-GB">Conclusion: </span><span>AKI was seen in 21.6% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE IV scores and ventilation requirement were correlated with higher mortality in AKI patients in ICU. Early recognisition and intervention improves the outcome.</span></p>

scholarly journals Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Boxiang Tu ◽  
Yuanjun Tang ◽  
Yi Cheng ◽  
Yuanyuan Yang ◽  
Cheng Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Propensity Score Methods ◽  
Statin Use

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p &lt; 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p &lt; 0.001] and ICU LOS [mean difference −0.51(−0.79, −0.24); p &lt; 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1.Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

scholarly journals Erratum to: Prevention of acute kidney injury and protection of renal function in the intensive care unit

2010 ◽  
Vol 36 (4) ◽  
pp. 727-727
Author(s):  
Michael Joannidis ◽  
Wilfred Druml ◽  
Lui G. Forni ◽  
A. B. Johan Groeneveld ◽  
Patrick Honore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury

scholarly journals Impact of Prior to Intensive Care Unit Statin use on Patients with Acute Kidney Injury

2021 ◽  
Author(s):  
Bo-Xiang Tu ◽  
Yuan-Jun Tang ◽  
Yi Cheng ◽  
Xiao-Bin Liu ◽  
Cheng Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Propensity Score Methods ◽  
Statin Use

Abstract Purpose: To evaluate if prior to intensive care unit (ICU) statin use improve the clinical outcomes, for critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV v1.0 database for this retrospective observational study. The primary outcome was 30-day ICU mortality. 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by multivariable cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariable linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: 3821 pre-ICU statin users and 9690 non-users were identified. In multivariable model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [Hazara ratio (HR) 0.68 (0.59,0.79); P<0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); P<0.001] and ICU LOS [Mean Difference -0.51(-0.79, -0.24); P<0.001]. The conclusions were consistent in three propensity score methods. In Subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, only except for 30-day ICU mortality in AKI stage 1.Conclusions: Patients with AKI who were administered statins prior to ICU admission might have lower mortality rate during ICU or hospital stay and shorter ICU LOS.

scholarly journals Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Jäckel ◽  
Nico Aicher ◽  
Jonathan Rilinger ◽  
Xavier Bemtgen ◽  
Eugen Widmeier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Stage I ◽  
Stage Ii ◽  
University Hospital ◽  
Psychiatric Disease ◽  
Daily Routine ◽  
Icu Stay

AbstractAcute kidney injury (AKI) and delirium are common complications on the intensive care unit (ICU). Few is known about the association of AKI and delirium, as well as about incidence and predictors of delirium in patients with AKI. In this retrospective study, all patients with AKI, as defined by the KDIGO (kidney disease improving global outcome) guideline, treated for more than 24 h on the ICU in an university hospital in 2019 were included and analyzed. Delirium was defined by a NuDesc (Nursing Delirium screening scale) ≥ 2, which is evaluated three times a day in every patient on our ICU as part of daily routine. A total of 383/919 (41.7%) patients developed an AKI during the ICU stay. Delirium was detected in 230/383 (60.1%) patients with AKI. Independent predictors of delirium were: age, psychiatric disease, alcohol abuse, mechanical ventilation, severe shock, and AKI stage II/III (all p < 0.05). The primary cause of illness had no influence on the onset of delirium. Among patients with AKI, the duration of the ICU stay correlated with higher stages of AKI and the presence of delirium (stage I/no delirium: median 1.9 (interquartile range (25th–75th) 1.3–2.9) days; stage II/III/no delirium: 2.6 (1.6–5.5) days; stage I/delirium: 4.1 (2.5–14.3) days; stage II/III/delirium: 6.8 (3.5–11.9) days; all p < 0.01). Delirium, defined as NuDesc ≥ 2 is frequent in patients with AKI on an ICU and independently predicted by higher stages of AKI.

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