Compromiso renal en pacientes con COVID-19 severa y crítica
DOI:
https://doi.org/10.29193/RMU.39.2.4Palabras clave:
INJURIA RENAL AGUDA, COVID-19Resumen
Introducción: la injuria renal aguda fue una complicación observada en forma frecuente en los pacientes críticos durante la pandemia por COVID-19. Objetivos: 1) determinar la incidencia de injuria renal aguda asociada a COVID-19 severa y crítica; 2) determinar la implicancia pronóstica en términos de morbimortalidad del compromiso renal.
Materiales y métodos: estudio prospectivo, observacional y analítico de una cohorte de pacientes con COVID-19 severa y crítica ingresados a la Unidad de Medicina Intensiva del Hospital Español. Se realizó un análisis descriptivo y analítico (univariado y mutivariado) y se empleo un nivel estadístico de significación menor a 0,05.
Resultados: n=233 pacientes con COVID-19 severa y crítica ingresados a la Unidad de Medicina Intensiva del Hospital Español entre 9/20 y 5/21. Injuria renal aguda asociada a COVID-19: 47,9% (107/233), injuria renal aguda severa (estadios KDIGO 2 y 3): 79,4% (85/107), injuria renal aguda nosocomial: 47,7% (52/107), enfermedad renal aguda: 41,1% (44/107), requerimiento de técnica de reemplazo renal: 29,9% (32/107).
La mortalidad al alta de medicina intensiva en pacientes con injuria renal aguda: 72,9% (78/107) versus sin injuria renal aguda: 48,4% (61/126) (p=0,000). El análisis multivariado mostró como factor predictivo protectivo de riesgo de muerte al alta de medicina intensiva a la función renal normal al egreso (OR 0,055, IC 95%: 0,014-0,213, p= 0,000).
Conclusiones: la incidencia de injuria renal aguda asociada a COVID-19 en medicina intensiva fue elevada, con un predominio de estadios 2-3 y se asoció con una mortalidad significativamente mayor. La normalización de la función renal se comportó como un factor predictivo protectivo de riesgo de muerte. El grado de soporte multiorgánico se asoció con un aumento progresivo de la mortalidad.
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Lamontagne F, Agarwal A, Rochwerg B, Siemieniuk RA, Agoritsas T, Askie L, et al. A living WHO guideline on drugs for covid-19. BMJ 2020; 370:m3379. doi: 10.1136/bmj.m3379.
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):747-64. doi: 10.1038/s41581-020-00356-5.
Kidney Disease: improving global outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1):1-138.
Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Bittleman D, 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):241-57. doi: 10.1038/nrneph.2017.2.
Domecq JP, Lal A, Sheldrick CR, Kumar VK, Boman K, Bolesta S, et al. Outcomes of patients with coronavirus disease 2019 receiving organ support therapies: the international viral infection and Respiratory Illness Universal Study Registry. Crit Care Med 2021; 49(3):437-48. doi: 10.1097/CCM.0000000000004879.
Chan KW, Yu KY, Lee PW, Lai KN, Tang SC. Global REnal Involvement of CORonavirus Disease 2019 (RECORD): a systematic review and metaanalysis of incidence, risk factors, and clinical outcomes. Front Med (Lausanne) 2021; 8:678200. doi: 10.3389/fmed.2021.678200.
Palevsky PM. COVID-19 and AKI: Where do we stand? J Am Soc Nephrol 2021; 32(5):1029-32. doi: 10.1681/ASN.2020121768.
Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI treated with renal replacement therapy in critically ill patients with COVID-19. J Am Soc Nephrol 2021; 32(1):161-76. doi: org/10.1681/ASN.2020060897.
Estenssoro E, Loudet CI, Ríos FG, Kanoore Edul VS, Plotnikow G, Andrian M, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study. Lancet Respir Med 2021; 9(9):989-98. doi: 10.1016/S2213-2600(21)00229-0.
Moledina DG, Simonov M, Yamamoto Y, Alausa J, Arora T, Biswas A, et al. The association of COVID-19 with acute kidney injury independent of severity of illness: a multicenter cohort study. Am J Kidney Dis 2021; 77(4):490-9.e1. doi: 10.1053/j.ajkd.2020.12.007.
Chebotareva N, Berns S, Berns A, Androsova T, Lebedeva M, Moiseev S. Acute kidney injury and mortality in coronavirus disease 2019: results from a cohort study of 1,280 patients. Kidney Res Clin Pract 2021; 40(2):241-9. doi: 10.23876/j.krcp.20.128.
Lu JY, Babatsikos I, Fisher MC, Hou W, Duong TQ. Longitudinal clinical profiles of hospital vs. community-acquired acute kidney injury in COVID-19. Front Med (Lausanne) 2021; 8:647023. doi: 10.3389/fmed.2021.647023.
Matsumoto K, Prowle JR. COVID-19-associated AKI. Curr Opin Crit Care 2022; 28(6):630-7. doi: 10.1097/MCC.0000000000000988.
Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and metaanalysis. Crit Care 2020; 24(1):356. doi: 10.1186/s13054-020-03065-4.
Silver SA, Beaubien-Souligny W, Shah PS, Harel S, Blum D, Kishibe T. The prevalence of acute kidney injury in patients hospi-talized with COVID-19 infection: a systematic review and metaanalysis. Kidney Med 2021; 3(1):83-98.e1. doi: 10.1016/j.xkme.2020.11.008.
Yang X, Tian S, Guo H. Acute kidney injury and renal re-placement therapy in COVID-19 patients: a systematic review and metaanalysis. Int Immunopharmacol 2021; 90:107159. doi: 10.1016/j.intimp.2020.107159.
Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kid Int 2020; 98(1):209-18. doi: 10.1016/j.kint.2020.05.006.
Feng YF, Wang KP, Mo JG, Xu YH, Wang LZ, Jin C, et al. The spatiotemporal trend of renal involvement in COVID-19: a pooled analysis of 17 134 patients. Int J Infect Dis 2021; 106:281-8. doi: 10.1016/j.ijid.2021.03.082.
Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute kidney injury in a national cohort of hospitalized US veterans with COVID-19. Clin J Am Soc Nephrol 2020; 16(1):14-25. doi: 10.2215/CJN.09610620.
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):751-64. doi: 10.1038/s41581-021-00452-0.
Charytan DM, Parnia S, Khatri M, Petrilli CM, Jones S, Benstein J, et al. Decreasing incidence of acute kidney injury in patients with COVID-19 critical illness in New York City. Kidney Int Rep 2021; 6(4):916-27. doi: 10.1016/j.ekir.2021.01.036.
Endre ZH, Mehta RL. Identification of acute kidney injury subphenotypes. Curr Opin Crit Care 2020; 26(6):519-24. doi: 10.1097/MCC.0000000000000772.
Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, et al. Association of Kidney Disease with outcomes in COVID-19: results from the American Heart Association COVID-19 Cardiovas-cular Disease Registry. J Am Heart Assoc 2021; 10(12):e020910. doi: 10.1161/JAHA.121.020910.
Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, et al. Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study. Ren Fail 2021; 43(1):911-8. doi: 10.1080/0886022X.2021.1933530.
Menon T, Sharma R, Kataria S, Sardar S, Adhikari R, Tousif S, et al. The association of acute kidney injury with disease severity and mortality in COVID-19: a systematic review and metaanalysis. Cureus 2021; 13(3):e13894. doi: 10.7759/cureus.13894.
Lin L, Wang X, Ren J, Sun Y, Yu R, Li K, et al. Risk factors and prognosis for COVID-19-induced acute kidney injury: a metaanalysis. BMJ Open 2020; 10(11):e042573. doi: 10.1136/bmjopen-2020-042573.
Birkelo BC, Parr SK, Perkins AM, Greevy RA Jr, Hung AM, Shah SC, et al. Comparison of COVID-19 versus influenza on the incidence, features, and recovery from acute kidney injury in hospitalized United States Veterans. Kidney Int 2021; 100(4):894-905. doi: 10.1016/j.kint.2021.05.029.
Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, et al. Safety of the BNT162b2 mRNA Covid-19 vaccine in a nationwide setting. N Engl J Med 2021; 385(12):1078-90. doi: 10.1056/NEJMoa2110475.
