Todd Brothers, PharmD, BCCCP, BCPS
Clinical Assistant Professor
University of Rhode Island
Kingston, Rhode Island
Disclosure information not submitted.
jacob Strock, MS
PhD. Candidate
University of Rhode Island
Kingston, Rhode Island, United States
Disclosure information not submitted.
Mohammad Al-Mamun, PhD.
Assistant Professor
West Virginia University
Morgantown, West Virginia, United States
Disclosure information not submitted.
Title: CLINICAL CHARACTERISTICS and OUTCOMES of ACUTE KIDNEY INJURY in CRITICALLY ILL ADULTS
INTRODUCTION: Acute kidney injury (AKI) is a frequent diagnosis among critically ill patients. However, the incidence and outcome of COVID-19-induced kidney injury have been variably described. This study aimed to identify clinical characteristics, correlates, and outcomes experienced by AKI patients during the COVID-19 pandemic.
Methods: A retrospective analysis was performed using electronic health records of 331 patients ( >18 years of age). AKI was defined based on the KDIGO guidelines. 226 patients were included as renal replacement therapy, kidney transplantation, and missing clinical information patients were excluded. The primary outcome was the incidence of AKI. Secondary outcomes were AKI recovery and in-hospital mortality. Cox regression models were used to analyze outcomes.
Results: 226 patients, 47.8% developed AKI. The incidence of AKI Stages 1, 2, and 3 were (34.3%, 36.1%, and 29.6%), respectively. Inpatient mortality was 13.7% and 51% had AKI. The COVID positive cohort (80%) was classified as AKI. AKI patients had higher BMI (30.8, IQR:24.1-36.5), SCr (1.8 mg/dL, IQR:0.8-2.1) PT (22.2, IQR:13.4-26.6), INR (2.2, IQR:1.3-2.7), RR (20.8 breaths/min, IQR:16.5-24), acidosis 43 (39.8%), hypo-osmolality and hyponatremia 45 (41.7%). AKI patients had lower eGFR (58.8, IQR:27.8-88.2 (ml/min/1.73) and GCS (11.7, IQR:9-15). COVID+AKI patients had higher rates of sepsis (30%) and acidosis (35%) compared to non-COVID AKI. When considering AKI as outcomes, AKI patients had higher TOMV (0, IQR: 4-72) and ICU length of stay (78.5 hours) compared to non-AKI patients (24 hours). Modeling revealed the highest mortality hazard for AKI stage 3 (HR: 4.72). AKI groups used anti-infectives (81%), diuretics (42.4%), and vasopressors (38%) more frequently. In the recovery cohort, analgesics (93.5%), anti-infectives (90.3%), and intravenous fluids (100%) use were most common. In the mortality group analgesics (100%), anti-infectives (100%), and vasopressors (100%) were used most frequently.
Conclusion: AKI incidence remains high and is associated with poorer outcomes. UO-based AKI classification was more sensitive than SCr alone. Despite particular medication classes correlating with the increased incidence of AKI, further investigation is warranted to examine a potential direct cause and effect relationship.