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Kidney Outcomes and Trajectories of Tubular Injury and Function in Critically Ill Persons with and without

Michael L Granda1, Frances Tian1, Leila R Zelnick1

  • 1University of Washington, Kidney Research Institute.

Research Square
|March 11, 2024
PubMed
Abstract

Insights

Critically ill adults with COVID-19 experienced significantly higher rates of major adverse kidney events and kidney replacement therapy. This indicates a more prolonged period of proximal tubular dysfunction in COVID-19 patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19 can cause kidney tubule injury through inflammation or direct viral effects.
  • Previous studies on COVID-19 kidney injury often lacked controls or single time-point measurements.
  • Understanding acute kidney injury (AKI) mechanisms in COVID-19 requires detailed comparison of kidney outcomes.

Approach:

  • The COVID-19 Host Response and Outcomes (CHROME) study prospectively enrolled critically ill patients.
  • COVID-19 status was confirmed via nucleic acid amplification.
  • Major adverse kidney events (MAKE), kidney biomarkers (KIM-1, EGF), and tubular function were assessed in COVID-19 positive and negative patients.

Key Points:

  • COVID-19 was linked to a 70% increase in MAKE and a 741% increase in kidney replacement therapy.
  • In COVID-19 negative patients, urine EGF, secretory clearance, and eGFR improved over time.
  • In COVID-19 positive patients, these markers remained unchanged, suggesting sustained tubular dysfunction.

Conclusions:

  • Critically ill adults with COVID-19 exhibit a more prolonged course of proximal tubular dysfunction.
  • COVID-19 significantly elevates risks for severe kidney injury and the need for kidney replacement therapy.
  • The study highlights persistent kidney tubular dysfunction as a key complication of severe COVID-19.
Keywords:
COVIDCOVID-19Coronavirus 2019acute kidney injuryegfkidneykim-1tubular injurytubular secretiontubules

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