Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium

Hannah Schaubroeck, Wim Vandenberghe, Willem Boer, Eva Boonen, Bram Dewulf, Camille Bourgeois, Jasperina Dubois, Alexander Dumoulin, Tom Fivez, Jan Gunst, Greet Hermans, Piet Lormans, Philippe Meersseman, Dieter Mesotten, Björn Stessel, Marc Vanhoof, Greet De Vlieger, Eric Hoste, Hannah Schaubroeck, Wim Vandenberghe, Willem Boer, Eva Boonen, Bram Dewulf, Camille Bourgeois, Jasperina Dubois, Alexander Dumoulin, Tom Fivez, Jan Gunst, Greet Hermans, Piet Lormans, Philippe Meersseman, Dieter Mesotten, Björn Stessel, Marc Vanhoof, Greet De Vlieger, Eric Hoste

Abstract

Background: Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr).

Methods: Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality.

Results: Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients.

Conclusions: Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915).

Keywords: Acute kidney injury; COVID-19; Epidemiology; Intensive care unit; KDIGO; Kidney replacement therapy; Mortality; Renal replacement therapy; Serum creatinine; Urine output.

Conflict of interest statement

EH received Speakers fees from Alexion, Sopachem and Astute Medical paid to the institution and a travel grant from AM Pharma. All other authors declare no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flowchart. Flowchart summarizing patient selection and inclusion process as well as number of patients with AKI according to the full KDIGO definition, to sCr or to UO criteria
Fig. 2
Fig. 2
Occurrence rate and ICU mortality of AKI stages. a Occurrence rate and b ICU mortality of AKI stages defined according to the full KDIGO definition and its components AKI-sCr and AKI-UO. AKI = acute kidney injury, AKI-sCr = AKI based on creatinine criteria only, AKI-UO = AKI based on urine output criteria only. Statistical significance of comparison of ICU mortality in AKI-sCr versus AKI-UO stages: AKI stage 0: p = 0.002; AKI stage 1: p < 0.001; AKI stage 2: p = 0.001; AKI stage 3: p = 0.070
Fig. 3
Fig. 3
Association between ICU mortality and AKI stages. Association between ICU mortality and AKI stage according to serum creatinine and/or urine output: a unadjusted, b adjusted

References

    1. Panel C-TG. National Institute of Health; 2021.
    1. COVID-19 Map [Internet]. Johns Hopkins Coronavirus Resource Center; 2021.
    1. Lumlertgul N, Pirondini L, Cooney E, Kok W, Gregson J, Camporota L, et al. Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study. Ann Intensive Care. 2021;11(1):123. doi: 10.1186/s13613-021-00914-5.
    1. Bayrakci N, Ozkan G, Sakaci M, Sedef S, Erdem I, Tuna N, et al. The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit. Ther apheresis Dial Off Peer-Rev J Int Soc Apheresis Jpn Soc Apheresis Jpn Soc Dial Ther. 2022 doi: 10.1111/1744-9987.13790.
    1. 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.
    1. Chand S, Kapoor S, Orsi D, Fazzari MJ, Tanner TG, Umeh GC, et al. COVID-19-associated critical illness-report of the first 300 patients admitted to intensive care units at a New York City Medical Center. J Intensive Care Med. 2020;35(10):963–970. doi: 10.1177/0885066620946692.
    1. 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.
    1. KDIGO. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.
    1. Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13(4):241–257. doi: 10.1038/nrneph.2017.2.
    1. Lameire NH, Levin A, Kellum JA, Cheung M, Jadoul M, Winkelmayer WC, et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2021;100(3):516–526. doi: 10.1016/j.kint.2021.06.028.
    1. Altman DG, Altman DG, Machin D, Altman DG. Statistics with confidence. 2. London: BMJ; 2000. p. 200.
    1. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care (Lond Engl) 2006;10(3):R73. doi: 10.1186/cc4915.
    1. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–1423. doi: 10.1007/s00134-015-3934-7.
    1. Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39(3):420–428. doi: 10.1007/s00134-012-2796-5.
    1. 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.
    1. Naar L, Langeveld K, El Moheb M, El Hechi MW, Alser O, Kapoen C, et al. Acute kidney injury in critically-ill patients with COVID-19: a single-center experience of 206 consecutive patients. Ann Surg. 2020;272(4):e280–e281. doi: 10.1097/SLA.0000000000004319.
    1. Alser O, Mokhtari A, Naar L, Langeveld K, Breen KA, El Moheb M, et al. Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: demographics and disease acuity matter more than comorbidities or treatment modalities. J Trauma Acute Care Surg. 2021;90(5):880–890. doi: 10.1097/TA.0000000000003085.
    1. Geri G, Darmon M, Zafrani L, Fartoukh M, Voiriot G, Le Marec J, et al. Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study. Ann Intensive Care. 2021;11(1):86. doi: 10.1186/s13613-021-00875-9.
    1. Wang F, Ran L, Qian C, Hua J, Luo Z, Ding M, et al. Epidemiology and Outcomes of Acute Kidney Injury in COVID-19 patients with acute respiratory distress syndrome: a multicenter retrospective study. Blood Purif. 2021;50(4–5):499–505. doi: 10.1159/000512371.
    1. Sharma P, Ng JH, Bijol V, Jhaveri KD, Wanchoo R. Pathology of COVID-19-associated acute kidney injury. Clin Kidney J. 2021;14(Suppl 1):i30–i39. doi: 10.1093/ckj/sfab003.
    1. Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021;17(11):751–764. doi: 10.1038/s41581-021-00452-0.
    1. Werion A, Belkhir L, Perrot M, Schmit G, Aydin S, Chen Z, et al. SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule. Kidney Int. 2020;98(5):1296–1307. doi: 10.1016/j.kint.2020.07.019.
    1. Scherer JS, Qian Y, Rau ME, Soomro QH, Sullivan R, Linton J, et al. Utilization of palliative care for patients with COVID-19 and acute kidney injury during a COVID-19 surge. Clin J Am Soc Nephrol: CJASN. 2022;17(3):342–349. doi: 10.2215/CJN.11030821.
    1. Investigators S-A, Canadian Critical Care Trials G, Australian, New Zealand Intensive Care Society Clinical Trials G, United Kingdom Critical Care Research G, Canadian Nephrology Trials N, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med. 2020;383(3):240–51. 10.1056/NEJMoa2000741.
    1. Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyere R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379(15):1431–1442. doi: 10.1056/NEJMoa1803213.
    1. Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet (Lond, Engl) 2021;397(10281):1293–1300. doi: 10.1016/S0140-6736(21)00350-0.
    1. Naorungroj T, Neto AS, Yanase F, Eastwood G, Wald R, Bagshaw SM, et al. Time to initiation of renal replacement therapy among critically ill patients with acute kidney injury: a current systematic review and meta-analysis. Crit Care Med. 2021;49(8):e781–e792. doi: 10.1097/CCM.0000000000005018.
    1. Xu J, Xie J, Du B, Tong Z, Qiu H, Bagshaw SM. Clinical characteristics and outcomes of patients with severe COVID-19 induced acute kidney injury. J Intensive Care Med. 2021;36(3):319–326. doi: 10.1177/0885066620970858.
    1. Md Ralib A, Pickering JW, Shaw GM, Endre ZH. The urine output definition of acute kidney injury is too liberal. Crit Care (Lond, Engl) 2013;17(3):R112. doi: 10.1186/cc12784.
    1. Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol. 2015;26(9):2231–2238. doi: 10.1681/ASN.2014070724.
    1. Macedo E, Malhotra R, Bouchard J, Wynn SK, Mehta RL. Oliguria is an early predictor of higher mortality in critically ill patients. Kidney Int. 2011;80(7):760–767. doi: 10.1038/ki.2011.150.
    1. McCullough PA, Bouchard J, Waikar SS, Siew ED, Endre ZH, Goldstein SL, et al. Implementation of novel biomarkers in the diagnosis, prognosis, and management of acute kidney injury: executive summary from the tenth consensus conference of the Acute Dialysis Quality Initiative (ADQI) Contrib Nephrol. 2013;182:5–12. doi: 10.1159/000349962.
    1. Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care (Lond, Engl) 2016;20(1):299. doi: 10.1186/s13054-016-1478-z.
    1. Kellum JA, Sileanu FE, Bihorac A, Hoste EA, Chawla LS. Recovery after acute kidney injury. Am J Respir Crit Care Med. 2017;195(6):784–791. doi: 10.1164/rccm.201604-0799OC.
    1. Papoutsi E, Giannakoulis VG, Xourgia E, Routsi C, Kotanidou A, Siempos II. Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies. Crit Care (Lond, Engl) 2021;25(1):121. doi: 10.1186/s13054-021-03540-6.
    1. Fierens J, De Bus L, Colpaert K, Boelens J, Gadeyne B, Decruyenaere J, et al. Antimicrobial prescription in severe COVID-19 and CAP: a matched case-control study. Acta Clin Belg. 2021 doi: 10.1080/17843286.2021.1996068.
    1. De Bruyn A, Verellen S, Bruckers L, Geebelen L, Callebaut I, De Pauw I, et al. Secondary infection in COVID-19 critically ill patients: a retrospective single-center evaluation. BMC Infect Dis. 2022;22(1):207. doi: 10.1186/s12879-022-07192-x.
    1. Verweij PE, Bruggemann RJM, Azoulay E, Bassetti M, Blot S, Buil JB, et al. Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. Intensive Care Med. 2021;47(8):819–834. doi: 10.1007/s00134-021-06449-4.

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