ACUTE KIDNEY INJURY IN PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID 19): PERSPECTIVES FROM PAKISTAN

Main Article Content

Dr. Omer Sabir
Dr. Aijaz Zeeshan Khan Chachar
Dr Mubashir Dilawar
Dr. Syeda Arzinda Fatima
Dr. Muhammad Kamran Rauf
Dr. Neelam Ijaz

Keywords

Coronavirus Disease 2019, COVID 19, Acute Kidney Injury, AKI, Renal replacement therapy.

Abstract

Kidney involvement in patients with Coronavirus Disease 2019 (COVID-19) can have variable presentations and clinical courses. Consequently, COVID 19 related Acute Kidney Injury (AKI) can increase the morbidity and mortality of these patients who are at increased risk of death consequent to non-renal organ involvement. Objectives: The present study aims to describe the clinical and epidemiological profile of patients with COVID-19 who have AKI during the course of their illness. Study Design: This was a retrospective review of data collected at four hospitals in Lahore, Pakistan from May 1, 2020, to June 30, 2020. A total of 445 patients were reviewed and analyzed. Patients designated as having AKI at admission, those who received Renal Replacement Therapy (RRT), and those patients with a history of chronic kidney disease (CKD) with superimposed AKI were included in the retrospective review.


Results: Out of 445 patients, 57 (12.8%) patients developed AKI.  The presence of AKI correlated significantly with history of diabetes, CKD, septic shock and need for invasive positive pressure ventilation. RRT showed a moderate correlation with death. D-dimers levels at presentation, presence of diabetes and septic shock also predicted death.


Conclusion: The incidence of AKI in COVID-19 patients reported from Pakistan aligns with global figures, with the need for renal replacement therapy serving as a prognostic marker for mortality in AKI cases.

Abstract 56 | pdf Downloads 23

References

1. Khan Chachar AZ, Khan K, Khan AA, Muhammad Imran Hasan K, Ashraf Zia M, Siddique N, Bin Younis B, Khan ZA. Clinical and Demographic Characteristics Including Comorbidities and Their Outcomes Among Patients Hospitalized With COVID-19 in Four Tertiary Care Hospitals Across Lahore. Cureus. 2021 Jan 12;13(1): e12663. doi: 10.7759/cureus.12663. PMID: 33604203; PMCID: PMC7880821.
2. WHO Coronavirus (COVID-19) Dashboard. (2024-9-06). World Health Organization. https://covid19.who.int.
3. Global – Pakistan. (2024-09-09). World Health Organization. https://covid19.who.int/region/emro/country/pk.
4. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8.
5. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8
6. Diao B, Wang C, Wang R, et al. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 infection. Nat Commun. 2021;12(1):2506. Published 2021 May 4. doi:10.1038/s41467-021-22781-1.
7. Yin W, Zhang PL. Infectious pathways of SARS-CoV-2 in renal tissue. J. Nephropath. 2020 Oct 1;9(4).
8. Mubarak M, Tolouian R, Pezeshgi A. Collapsing glomerulopathy following COVID-19 infection; possible relationship with APOL1 kidney risk alleles in African-Americans. Immunopathol Persa. 2020;6(2):e18. DOI:10.34172/ipp.2020.18.
9. Chen X, Zhao B, Qu Y, et al. Detectable Serum Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load (RNAemia) Is Closely Correlated With Drastically Elevated Interleukin 6 Level in Critically Ill Patients With Coronavirus Disease 2019. Clin Infect Dis. 2020;71(8):1937-1942. doi:10.1093/cid/ciaa449.
10. Zumla A, Hui DS, Azhar EI, Memish ZA, Maeurer M. Reducing mortality from 2019-nCoV: host-directed therapies should be an option. Lancet. 2020;395(10224):e35-e36. doi:10.1016/S0140-6736(20)30305-6
11. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Feb 15;395(10223):496. doi: 10.1016/S0140-6736(20)30252-X.]. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
12. Wang L, Li X, Chen H, et al. Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China. Am J Nephrol. 2020;51(5):343-348. doi:10.1159/000507471.
13. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-838. doi:10.1016/j.kint.2020.03.005.
14. Pei G, Zhang Z, Peng J, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J Am Soc Nephrol. 2020;31(6):1157-1165. doi:10.1681/ASN.2020030276.
15. Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218. doi:10.1016/j.kint.2020.05.006.
16. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area [published correction appears in JAMA. 2020 May 26;323(20):2098. doi: 10.1001/jama.2020.7681.]. JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775.
17. Teoh JY, Yip TC, Lui GC, et al. Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019. J Am Soc Nephrol. 2021;32(4):961-971. doi:10.1681/ASN.2020071097.
18. Marini JJ, Gattinoni L. Management of COVID-19 Respiratory Distress. JAMA. 2020;323(22):2329-2330. doi:10.1001/jama.2020.6825.
19. Querol-Ribelles JM, Tenias JM, Grau E, et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest. 2004;126(4):1087-1092. doi:10.1378/chest.126.4.1087.
20. Fruchter O, Yigla M, Kramer MR. D-dimer as a prognostic biomarker for mortality in chronic obstructive pulmonary disease exacerbation. Am J Med Sci. 2015;349(1):29-35. doi:10.1097/MAJ.0000000000000332.
21. Snijders D, Schoorl M, Schoorl M, Bartels PC, van der Werf TS, Boersma WG. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. Eur J Intern Med. 2012;23(5):436-441. doi:10.1016/j.ejim.2011.10.019.
22. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038. doi: 10.1016/S0140-6736(20)30606-1.] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038. doi: 10.1016/S0140-6736(20)30638-3.]. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3.
23. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032.
24. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382-386. Published 2020 Apr 3. doi:10.15585/mmwr.mm6913e2.
25. Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States [published correction appears in J Diabetes Sci Technol. 2023 Nov;17(6):1740. doi: 10.1177/1932296820932678.]. J Diabetes Sci Technol. 2020;14(4):813-821. doi:10.1177/1932296820924469.
26. Quah P, Li A, Phua J. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Crit Care. 2020;24(1):285. Published 2020 Jun 4. doi:10.1186/s13054-020-03006-1.
27. Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-887. doi:10.1007/s00134-020-06022-5.
28. Ruan Q, Yang K, Wang W, Jiang L, Song J. Correction to: Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(6):1294-1297. doi:10.1007/s00134-020-06028-z.
29. Rieg S, von Cube M, Kalbhenn J, et al. COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany. PLoS One. 2020;15(11):e0242127. Published 2020 Nov 12. doi:10.1371/journal.pone.0242127.

Most read articles by the same author(s)