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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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COVID-19-associated coagulopathy and acute kidney injury in critically ill patients

Bruno Caldin da Silva1, Ricardo Luiz Cordioli1, Bento Fortunato Cardoso Dos Santos1

  • 1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Einstein (Sao Paulo, Brazil)
|September 20, 2023
PubMed

Insights

Critically ill COVID-19 patients with acute kidney injury (AKI) had lower levels of natural anticoagulants, specifically antithrombin and protein C. These findings suggest a potential role for endogenous anticoagulants in AKI development in this population.

Area of Science:

  • Critical care medicine
  • Nephrology
  • Hematology

Background:

  • Thrombotic events and acute kidney injury (AKI) are prevalent complications in critically ill COVID-19 patients.
  • Understanding the underlying mechanisms, particularly coagulation abnormalities, is crucial for managing these patients.

Purpose of the Study:

  • To compare coagulation profiles in critically ill COVID-19 patients who developed AKI versus those who did not.
  • To investigate the role of endogenous anticoagulants in the development of AKI in this patient cohort.

Main Methods:

  • Coagulation tests, platelet function, fibrinolysis, and rotational thromboelastometry were performed on days 0, 1, 3, 7, and 14 post-ICU admission.
  • Patients were stratified into two groups: those who developed AKI and those who did not.

Main Results:

  • Patients with AKI were older and had lower baseline glomerular filtration rates.
  • While D-dimer, fibrinogen, and rotational thromboelastometry results were similar between groups, antithrombin activity and protein C levels were significantly lower in patients who developed AKI.
  • Lower protein C levels were observed consistently throughout the intensive care unit stay in the AKI group.

Conclusions:

  • Critically ill COVID-19 patients who developed AKI demonstrated reduced levels of endogenous anticoagulants.
  • Further research is warranted to elucidate the specific role of natural anticoagulants in the pathophysiology of AKI in critically ill COVID-19 patients.
Abstract

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