Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Annals of Intensive Care

Research

Emma Pearson¹  Nicholas A. Barrett¹  Eleanor Baker¹  Jacqueline Pan¹  Anup Jheeta¹  Richard Leach¹  Marlies Ostermann¹  Kittisak Weerapolchai²  Nuttha Lumlertgul³  Yanzhong Wang⁴  Kathryn V. Dalrymple⁴ 

[1] Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, SE1 7EH, London, UK;Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, SE1 7EH, London, UK;Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, SE1 7EH, London, UK;Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Centre of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Department of Population Health Sciences, King’s College London, London, UK;

关键词: Acute kidney injury;    COVID-19;    Critically ill;    Kidney replacement therapy;    Wave;   

DOI  :  10.1186/s13613-022-01094-6

 received in 2022-07-13, accepted in 2022-12-08,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAcute 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).MethodsThis 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.ResultsA 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).ConclusionsIn 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.

【 授权许可】

CC BY   
© The Author(s) 2022

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