HYPERURICEMIA AND HIGH CREATINE KINASE AS ACUTE KIDNEY INJURY RISK FACTORS IN COVID 19 PATIENTS

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https://storage.unitedwebnetwork.com/files/1099/8549599458743e7f4bbf0edf0b97586a.pdf

Abstract Title

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Lillana

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Pacchiano Aleman

Co-author 1

Gustavo Alejandro Casas Aparicio gustavo.casas@cieni.org.mx Instituto Nacional de Enfermedades Respiratorias Nephrology Mexico City

Co-author 2

Rosario Fernández Plata rosario.fernandez@iner.gob.mx Instituto Nacional de Enfermedades Respiratorias Clinical Research Mexico City

Co-author 3

David Martínez Briseño mb3david@gmail.com Instituto Nacional de Enfermedades Respiratorias Clinical Research Mexico City

Co-author 4

Anjarath Higuera Iglesias higuera.iglesias.anjarath@gmail.com Instituto Nacional de Enfermedades Respiratorias Clinical Research Mexico City

Co-author 5

Manuel Castillejos López mcastillejos@gmail.com Instituto Nacional de Enfermedades Respiratorias Clinical Research Mexico City

Co-author 6

Co-author 7

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Introduction

Severe COVID-19 disease can be associated with an increased catabolic state resulting in hyperuricemia (HyperAU) and high creatine kinase (HyperCK). HyperAU and Hyper CPK could increase the risk for severe Acute Kidney Injury (AKI) defined by KDIGO as stages 2 and 3. The main purpose of this research project is to analyze hyperuricemia (HyperAU) and high creatin kinase (Hyper CPK) as risk factors for severe AKI development in a cohort of severe COVID-19 patients.

Methods

We analyzed a retrospective and longitudinal cohort; hospitalized patients between March 2020 to August 2021 with a SARS-COV 2 positive test, age > 18 years and PAFI < 300 mmHg at admission were included. HyperUr was defined as uric acid level (UA) > 7.0 mg/dl in men or >6.5 mg/dl in women in at least a value registered in the initial five days of hospitalization. Hyper CPK was defined as serum creatin kinase levels >5000 UI/ml in at least a value taken at the same time interval as uric acid. AKI was defined by KDIGO guidelines and classified accordingly. Descriptive statistics were performed as well as comparations between two defined groups: with and without severe AKI. The Cox regression model univariate and multivariate was used as well as survival curves using the Kaplan Mier method between both groups. P < 0.05 was considered a statistically significant difference.

Results

We included 3,022 patients with severe COVID-19; 34% died and 28.8% developed AKI. 759 patients (25.1%) presented with HyperUA, 115 patients (3.8%) with Hyper CPK; 66 patients (2.22%) presented with both. HyperUr and Hyper CPK were associated with severe AKI after adjustment for age and gender. (Table 1). Severe AKI developed in less time in those patients with HyperAU, Hyper CPK and in patients presenting with both (log rank test p <0.001).

	HR unadjusted (95% CI)	p value	HR adjusted (95% CI)	p value
HyperAU	1.91 (1.63-2.24)	<0.001	1.91 (1.62-2.24)	<0.001
Hyper CPK	1.55 (0.95-2.53)	0.078	1.55 (0.91-2.43)	0.118
HyperAU and Hyper CPK	2.80 (2.02-3.87)	<0.001	2.80 (1.93-3.72)	<0.001

Conclusions

AKI was a common complication among our severe COVID-19 patient cohort; hyperuricemia is an independent risk factor for severe AKI and this risk also increases in patients presenting with elevated serum creatine kinase.

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