Study reveals kidney disease or injury is associated with mu
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New research published in Anaesthesia reveals the much higher risk of mortality faced by COVID-19 patients in intensive care who have chronic kidney disease (CKD) or, those who develop new (acute) kidney injury (AKI) as a result of developing COVID-19.

This new study examined the association between AKI and CKD with clinical outcomes in 372 patients with COVID-19 admitted to four regional ICUs in the UK. The average age of the patients was around 60 years, and 72% of them were male. Also of note was the fact that the majority of patients were of Black, Asian of Ethnic Minority (BAME) background (281 patients, 76%).

A total of 216 (58%) patients had some form of kidney impairment (45% developed AKI during their ICU stay, while 13% had pre-existing CKD), while 42% had no CKD or AKI. The patients who developed AKI had no history of serious kidney disease before their ICU admission (known from blood tests either at admission to hospital or from their medical records), suggesting that the AKI was directly related to their COVID-19 infection.

The authors found that patients with no kidney injury or disease had a mortality of 21% (32/156 patients). Those with new onset AKI caused by the COVID-19 virus had a mortality of 48% (81/168), whilst for those with pre-existing CKD (Stages 1-4) mortality was 50% (11 /22). In those patients with end-stage kidney failure (i.e. CKD stage 5), where they already required regular out-patient dialysis, mortality was 47% (9 of 19 patients). Mortality was greatest in those patients with kidney transplants, with 6 out of 7 patients (86%) dying, highlighting that these patients are an extremely vulnerable group.

The investigators also examined the rates of renal replacement therapy, a form of hospital dialysis, due to COVID-19 in these ICU patients with kidney injury. Out of 216 patients with any form of kidney impairment, 121 (56%) patients required renal replacement therapy (see Table 2 full paper). Of the 48 survivors who needed dialysis for the first time during their ICU stay, 9 patients (19%) had to continue with dialysis after discharge from ICU, suggesting COVID-19 may lead to chronic kidney problems.

"To the best of knowledge, this is the first comprehensive analysis of outcomes in critically unwell COVID-19 patients in the UK with kidney failure, particularly in patients with pre-existing chronic kidney disease," say the authors.

The reasons for the increased mortality in patients with kidney problems are not clearly understood. There are several theories, including that the COVID-19 virus causes endotheliitis, an inflammation of the blood vessels in the kidneys, which is similar to the problem COVID-19 is known to cause in the lungs. Other reports have suggested that there could be direct kidney injury from the cytokine-induced immune system inflammatory response (where the body is overwhelmed by its own immune response, the so-called cytokine storm), and also death of kidney tissue related to multi-organ failure caused by COVID-19.

Source: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15293
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