Vasoactive drugs and acute kidney injury

A central objective in the management of acute kidney injury is the restoration and maintenance of adequate systemic and renal perfusion, often requiring the parallel administration of fluids and vasoactive drugs. However, hypovolaemia and fluid overload may both predispose the patient to complications and poor outcomes. Therefore, body weight and daily fluid intake/output should be recorded, patients should continuously be assessed for clinical signs of under- or over-hydration, and adequate monitoring of haemodynamic parameters should be performed. Together these parameters constitute the basis for individualized fluid therapy that needs to be initiated promptly and should be re-evaluated at least on a daily basis.

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Acute kidney injury in patients with severe COVID-19 in Mexico

10.1101/2020.08.28.20167379 ◽

2020 ◽

Author(s):

GUSTAVO CASAS ◽

MARIA-ISABEL LEON ◽

MAURICIO GONZALEZ-NAVARRO ◽

CLAUDIA ALVARADO DE LA BARRERA ◽

Santiago Avila-Rios ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Serum Creatinine ◽

Systemic Disease ◽

Invasive Mechanical Ventilation ◽

Laboratory Data ◽

Kidney Injury ◽

Vasoactive Drugs ◽

D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

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Acute kidney injury in patients with severe COVID-19 in Mexico

PLoS ONE ◽

10.1371/journal.pone.0246595 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246595

Author(s):

Gustavo A. Casas-Aparicio ◽

Isabel León-Rodríguez ◽

Claudia Alvarado-de la Barrera ◽

Mauricio González-Navarro ◽

Amy B. Peralta-Prado ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Stress Test ◽

Systemic Disease ◽

Invasive Mechanical Ventilation ◽

Laboratory Data ◽

Kidney Injury ◽

Severe Pneumonia ◽

Older Age ◽

Vasoactive Drugs

Introduction Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01–1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8–24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29–29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48–20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16–24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24–33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%. Conclusions AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2–3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.

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Vasoactive drugs and acute kidney injury

Critical Care Medicine ◽

10.1097/ccm.0b013e318169167f ◽

2008 ◽

Vol 36 (Suppl) ◽

pp. S179-S186 ◽

Cited By ~ 99

Author(s):

Rinaldo Bellomo ◽

Li Wan ◽

Clive May

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Vasoactive Drugs

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Impact of acute kidney injury on in-hospital outcomes in Chinese patients with community acquired pneumonia

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01511-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dawei Chen ◽

Hongbo Yuan ◽

Changchun Cao ◽

Zhihe Liu ◽

Linglin Jiang ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Invasive Mechanical Ventilation ◽

Kidney Injury ◽

Community Acquired Pneumonia ◽

Chinese Patients ◽

Vasoactive Drugs ◽

Hospital Outcomes ◽

Independent Risk Factors

Abstract Background Acute kidney injury (AKI) is a frequent complication of community acquired pneumonia (CAP). However, the impact of AKI on in-hospital outcomes of patients with CAP in the Chinese population remains unclear. Methods Patients diagnosed with CAP were evaluated in this retrospective observational study. Multiple Cox regression models were employed to identify the association between AKI and in-hospital mortality and 30-day mortality, respectively. Results A total of 4213 patients were recruited; 950 (22.5%) patients were diagnosed with AKI. Independent risk factors for AKI were age, male gender, hypertension, cardiac dysfunction, diabetes, chronic kidney disease, acute respiratory failure, use of diuretics, use of vasoactive drugs, and CURB-65. Cox proportional hazards regression revealed AKI, use of angiotensin receptor blocker, hypertension, CURB-65, acute respiratory failure, and use of vasoactive drugs to be independent risk factors for both in-hospital and 30-day mortality. Compared to patients without AKI, those suffering AKI were found to have 1.31-fold (HR 1.31, 95% CI, 1.04–1.66; P = 0.023) and 1.29-fold (HR 1.29, 95% CI, 1.02–1.62; P = 0.033) increased in-hospital and 30-day mortality risks, respectively. In addition, patients with AKI were likely to require admission to intensive care unit (ICU) (42.9% versus 11.4%; P < 0.001), mechanical ventilation (33.8% versus 9.3%; P < 0.001), invasive mechanical ventilation (25.9% versus 5.8%; P < 0.001), non-invasive mechanical ventilation (25.4% versus 7.1%; P < 0.001), and experienced a longer duration of hospital stay (14 days versus 10 days; P < 0.001) than those without AKI. However, no significant difference in ICU stay (11 days versus 10 days; P = 0.099) and duration of mechanical ventilation (8 days versus 8 days; P = 0.369) between AKI and non-AKI groups was found. Conclusion AKI was common in Chinese patients with CAP. Patients with CAP who developed AKI had worse in-hospital outcomes.

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Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0251048 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251048

Author(s):

Danilo Candido de Almeida ◽

Maria do Carmo Pinho Franco ◽

Davi Rettori Pardo dos Santos ◽

Marina Colella Santos ◽

Isabela Soucin Maltoni ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Univariate Analysis ◽

Kidney Injury ◽

University Hospital ◽

Injury Incidence ◽

Vasoactive Drugs ◽

Reactive Protein ◽

Incidence Risk ◽

Potential Risk Factors

Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. Methods We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. Results First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. Conclusions In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.

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