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The AKI in patients with Covid-19 infection has been found to be a serious illness, the mortality rate among patients has been reported to vary between 20 and 76%.Kidney injury results from systemic effects of COVID-19 illness such as septic shock, or Nephrotoxins as well as from direct cytopathic effects of virus. Several electrolyte abnormalities (dysnatremias, hypo- and hyperkalemia, and hypocalcemia) are reported in patients with COVID-19 infection and may be a manifestation of renal injury due to COVID-19 illness or may be a result of other pathophysiology, e.g., syndrome of inappropriate antidiuretic hormone (SIADH). The severity of AKI, age, and various scores of patient illness, such as Sequential Organ Failure Assessment (SOFA), D-dimers, bilirubin, oliguria in patients on renal replacement therapy (RRT), etc., have been reported to be predictors of mortality in the subgroup of patients with AKI. Factors associated with mortality in patients with AKI and COVID-19 illness are understudied and under-reported in India. Our objective was to determine which factors conferred an increased odds of death for patients admitted to a hospital with COVID-19 and AKI.
We carried out a retrospective medical record review to find the outcome of COVID-19 patients with AKI and the factors associated with mortality.The study subjects included patients admitted between March 23, 2021, and June 30, 2021, during the second wave of the Covid-19 pandemic. The most dominant strain during the second wave in India reported was SARS-Co-V-2 lineage B.1.617.The inclusion criteria were:1) age between 18 and 80 years, 2) COVID-19 diagnosed by positive RT-PCR, (3) patient should have the presence of AKI either on admission or during stay for which a nephrology consultation was sought.
AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline, based on changes in serum creatinine.Baseline creatinine was used when available or was calculated by comparing the peak creatinine with the lowest creatinine during hospitalization, assuming it to represent baseline kidney function. We also assessed AKI on admission (pre-hospitalization AKI) by comparing the admission creatinine with the lowest creatinine during hospitalization or previously available baseline creatinine. This was done to determine whether AKI was present at the time of admission. Pre-hospitalization AKI was defined as an increase of creatinine by greater than 0.3mg/dL. Acute Disease Quality Initiative (ADQI) 16 Workgroup definitions of AKI recovery to classify AKI recovery, rapid recovery, persistent AKI, and AKD.Other exposures included demographic factors, factors of COVID-19 infection severity (need for vasopressors, ventilator, need for ICU, length of admission), co-morbidities, and lab parameters.
Statistical analysis was performed on R version4.0.Median (25th-75th percentile)was used for numerical variables and frequency (percentage) for nominal variables. We stratified the various demographic, clinical, and biochemical factors across those who died or were discharged.Chi-squared test was used to compare distribution in case of nominal variables and the Mann-Whitney test in case of numerical variables. A stepwise logistic regression models, was performed based on factors selected from the univariate analysis.
The study indicates the potential association of hypernatremia with mortality in AKI, along with the simultaneous presence of multiple co-morbidities with COVID-19. As the statistical power of the association is weak, we are claiming the association as potential only. It needs to be confirmed in other larger studies.