New research presented at Euroanaesthesia, the annual meeting of the European Society of Anesthesiology and Intensive Care (ESAIC), held online this year, suggests that among COVID-19 patients admitted to the intensive care unit (ICU ), those with sudden deterioration in kidney function are more likely to die during a hospital stay than people with pre-existing kidney disease. In addition, kidney replacement therapy (like dialysis) does little to improve their chances of survival.
Sudden loss of kidney function – a condition known as acute kidney failure (AKI) – affects more than a quarter of patients hospitalized with COVID-19 . Previous studies suggest that kidney damage in COVID-19 patients is linked to a higher risk of death. But the results of patients hospitalized with COVID-19 and AKI are not well understood. In severe AKI, kidney function can be replaced with dialysis, which removes toxins and excess fluids, as well as salts that build up in the bloodstream.
To investigate whether AKI in COVID-19 patients without prior kidney disease correlates with higher mortality and whether this risk can be reduced by dialysis, Austrian researchers retrospectively examined all 129 patients with confirmed COVID-19 in two intensive care units a large teaching hospital in Vienna between September 1stst, 2020 and February 15that, 2021. The mean age of the patients was 66.5 years and two-thirds were male.
The patients were divided into three groups: patients with a history of kidney disease at admission (33 patients); Previously healthy kidney patients who developed acute kidney damage on the fifth day of their stay in the intensive care unit (patients with an estimated glomerular filtration) [eGFR] Speed of <90 ml / min; 26 patients); and those with normal kidney function both before admission and on the fifth day of their intensive care stay (eGFR ≥ 90 ml / min; 70 patients). All patients were followed up until the end of their stay in the intensive care unit. A total of 32 patients required renal replacement therapy.
The researchers found that 55% (18 of 33) of patients with a history of kidney disease, 46% (12 of 26) of patients with AKI, and 83% (58 of 70) of patients with normal kidney function made their stay on the go ICU survived – shows a highly significant difference in survival between the three groups.
In the two groups with renal impairment, the probability of survival was significantly below average, which indicates a higher risk of death compared to normal kidney function. The results suggest that neither the earlier start of dialysis nor the number of dialysis days had a significant impact on survival.
“Our results confirm that kidney dysfunction is a major risk factor for COVID-19-related deaths in intensive care patients. Above all, however, they suggest that COVID-19 patients who develop acute kidney damage are at a higher risk of dying in the intensive care unit than patients with pre-existing chronic kidney disease, “says lead author Katharina Oberneder from Sigmund-Freud -Private University. Vienna, Austria. “Ultimately, it is all about the early detection of acute kidney dysfunction and how we can use these results to improve the care of seriously ill COVID-19 patients.”
The researchers hope to do more research to better understand how various factors affect outcomes in this population and to gain more insight into how best to treat this high-risk group.
The authors point out that their results are observational results and are limited to a small number of patients in a hospital in Vienna and that their data may be limited by their retrospective nature.
European Journal of Anaesthesiology
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