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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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  11. Impact Of Dexamethasone In Severe Covid-19-induced Acute Kidney Injury: A Multicenter Cohort Study

Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study

Sébastien Rubin1,2, Arthur Orieux3, Mathilde Prezelin-Reydit4,5

  • 1Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France. sebastien.rubin@chu-bordeaux.fr.

Annals of Intensive Care
|February 13, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Dexamethasone (DXM) reduced the risk of acute kidney injury (AKI) in critically ill COVID-19 patients. This finding suggests that inflammation-driven AKI in severe COVID-19 may be preventable with DXM treatment.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Severe COVID-19 frequently causes acute kidney injury (AKI) in intensive care unit (ICU) patients.
  • Inflammation is implicated in AKI pathogenesis, with dexamethasone (DXM) showing potential benefits.
  • Previous small studies suggested DXM may protect against AKI in COVID-19.

Purpose of the Study:

  • To evaluate the preventive effect of dexamethasone (DXM) on AKI occurrence.
  • To investigate DXM's impact in a multicenter cohort of severe COVID-19 patients.

Main Methods:

  • Multicenter study of 798 severe COVID-19 ICU patients (March 2020-August 2021).
  • Exclusion of patients with pre-existing AKI or prior DXM use.
  • Multivariate Cox models analyzed the association between DXM administration at ICU entry and AKI development, accounting for temporal practice changes.
Keywords:
Acute kidney injuryCOVID-19DexamethasoneIntensive care unit

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Main Results:

  • AKI developed in 75% of patients; 10% required renal replacement therapy.
  • Patients receiving DXM showed a significantly reduced hazard of AKI (HR 0.67; 95% CI 0.55-0.81).
  • Results remained consistent across sensitivity analyses, including those adjusting for DXM timing and COVID-19 pandemic waves.

Conclusions:

  • Dexamethasone administration was associated with a decreased risk of AKI in severe COVID-19 ICU patients.
  • These findings support the hypothesis that inflammatory mechanisms in AKI are potentially targetable and preventable.
  • DXM may be a valuable therapeutic option for preventing AKI in this patient population.