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Endothelial Dysfunction for Acute Kidney Injury in Coronavirus Disease 2019: How Concerned Should We Be?

Yung-Chang Chen1,2, Ji-Tseng Fang1,2, Chih-Wei Yang1,2

  • 1Department of Nephrology, Kidney Research Center, Taipei, Taiwan.

Nephron
|May 27, 2021
PubMed

Insights

Critically ill COVID-19 patients who develop acute kidney injury requiring kidney replacement therapy face a high mortality risk. Predictors include higher BMI, CKD stage, and lower oxygenation levels upon ICU admission.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) pandemic presents significant challenges in critical care.
  • Kidney dysfunction, particularly acute kidney injury (AKI), is a frequent complication in severe COVID-19.
  • AKI in COVID-19 patients is associated with substantially worse clinical outcomes and increased mortality.

Purpose of the Study:

  • To investigate the incidence and predictors of AKI requiring kidney replacement therapy (KRT) in critically ill COVID-19 patients.
  • To identify factors associated with mortality in COVID-19 patients who develop AKI-KRT.
  • To analyze the relationship between patient characteristics, disease severity, and AKI development in the context of COVID-19.

Main Methods:

  • Multicenter retrospective observational study (STOP-COVID).
  • Enrolled 3,099 critically ill adult COVID-19 patients admitted to intensive care units (ICUs).
  • Analyzed data on AKI development, need for KRT, and 28-day mortality, alongside patient demographics and clinical parameters.

Main Results:

  • 20.6% of patients developed AKI requiring KRT (AKI-KRT) within 14 days of ICU admission.
  • Mortality within 28 days of ICU admission was 54.9% among patients with AKI-KRT.
  • Predictors for AKI-KRT included higher BMI, advanced chronic kidney disease (CKD) stages, lower PaO2:FiO2 ratio, and increased vasopressor use on ICU admission.

Conclusions:

  • Critically ill COVID-19 patients developing AKI requiring KRT have a very high mortality rate.
  • Patient factors like obesity and pre-existing kidney disease, along with acute illness severity (hypoxia, vasopressor need), are key predictors of AKI-KRT.
  • These findings highlight the critical role of kidney function monitoring and management in severe COVID-19 care.
Abstract

Keywords:
Acute kidney injuryCoronavirus disease 2019Endothelial dysfunctionIntensive care unit

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