Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Clinical Course of Cancer Patients with COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Naomi Alpert ◽  
Joseph L Rapp ◽  
Bridget Marcellino ◽  
Wil Lieberman-Cribbin ◽  
Raja Flores ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Cancer Treatments ◽  
Patients With Cancer ◽  
Significant Difference

Abstract Background Complications in cancer patients with COVID-19 have not been examined. This analysis aimed to compare characteristics of COVID-19 patients with and without cancer, and assess whether cancer is associated with COVID-19 morbidity or mortality. Methods COVID-19 positive patients with an inpatient or emergency encounter at the Mount Sinai Health System between March 1, 2020 and May 27, 2020 were included, and compared across cancer status on demographics and clinical characteristics. Multivariable logistic regressions were used to model the associations of cancer with sepsis, venous thromboembolism, acute kidney injury, intensive care unit admission, and all-cause mortality. Results There were 5,556 COVID-19 positive patients included; 421 (7.6%) with cancer (325 solid, 96 non-solid). Those with cancer were statistically significantly older, more likely to be non-Hispanic Black and to be admitted to the hospital during their encounter, and had more comorbidities than non-cancer COVID-19 patients. Cancer patients were statistically significantly more likely to develop sepsis (adjusted odds ratio [ORadj]=1.31, 95% confidence interval [CI]=1.06-1.61) and venous thromboembolism (ORadj=1.77, 95% CI = 1.01-3.09); there was no statistically significant difference in acute kidney injury (ORadj=1.10, 95% CI = 0.87-1.39), intensive care unit admissions (ORadj=1.04, 95% CI = 0.80-1.34), or mortality (ORadj=1.02, 95% CI = 0.81-1.29). Conclusions COVID-19 patients with cancer may have a higher risk for adverse outcomes. Although there was no statistically significant difference in mortality, COVID-19 patients with cancer have significantly higher risk of thromboembolism and sepsis. Further research is warranted into the potential effects of cancer treatments on inflammatory and immune responses to COVID-19, and on the efficacy of anticoagulant therapy in these patients.

Impact of reactive gastrostomy tube placement on clinical course of oropharynx cancer patients treated with chemoradiation.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17540-e17540
Author(s):  
Ami A Dave ◽  
Marisa A Mozer ◽  
Yanyu Zhang ◽  
Neilayan Sen ◽  
Monica Bojko ◽  
...  
Keyword(s):  
Weight Loss ◽  
Acute Kidney Injury ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Percutaneous Gastrostomy ◽  
Oropharynx Cancer ◽  
Significant Difference

e17540 Background: Prophylactic percutaneous gastrostomy tube (PEG) insertion reduces toxicity from chemoradiation to the head and neck but is thought to increase long term feeding tube dependence. This study retrospectively examines incidence and risk factors for treatment related complications of oropharynx cancer patients with and without prophylactic PEGs. Methods: Rush University Medical Center oropharynx cancer patients who received definitive chemoradiation treatment between 2007-2018 were included. Classifications were: “therapeutic” PEG (pretreatment for immediate use due to inability to swallow), prophylactic PEG, reactive PEG (patient/physician preference or 10% weight loss from baseline), and no PEG inserted on treatment. We compared patients with reactive or no PEG to (1) patients with prophylactic PEG, and (2) patients with prophylactic PEG and therapeutic PEG. Multivariate linear and logistical regression models were used to test PEG effect on weight loss, hospital admission, and incidence of acute kidney injury (AKI). Models were adjusted for covariates (age, gender, race, HTN, CAD, DM, other comorbidity). Acute kidney injury (AKI) was creatinine 1.5-2x above baseline. Results: In all, 104 patients were included with mean age 60.1 (SD = 8.65) and baseline BMI 29.6 (SD = 5.62). 53.4% (N = 55) had a prophylactic PEG, 38.8% (N = 40) had reactive or no PEG, 7.8% (N = 8) had a therapeutic PEG. 80 (76.9%) were treated with cisplatin. For all patients, analyses showed that reactive PEG or no PEG patients were more likely to develop AKI during treatment compared to patients with a prophylactic PEG (OR:3.2, p = 0.03), and to patients with prophylactic PEG and therapeutic PEG combined (OR:3.5, p = 0.02). There were no statistically significant differences between PEG groups for weight loss and hospital admission rate. In cisplatin treated patients, reactive PEG or no PEG patients were more likely to be admitted to the hospital compared to prophylactic PEG patients (OR:3.8, p = 0.04). Compared to patients with prophylactic and therapeutic PEG combined, however, there was no statistically significant difference. Patients with reactive or no PEG were more likely to have AKI than prophylactic PEG (OR:5.2, p < 0.01), and as compared to patients with therapeutic or prophylactic PEG (OR:4.4, p = 0.02). Conclusions: Reactive PEGs were associated with increased AKI and hospitalizations compared with prophylactic PEG. With a reactive PEG model, patients may need to have routine lab work and monitoring adjusted to reduce treatment complications.

scholarly journals Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Prateek Lohia ◽  
Kalyan Sreeram ◽  
Paul Nguyen ◽  
Anita Choudhary ◽  
Suman Khicher ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Respiratory Diseases ◽  
Severe Disease ◽  
Primary Objective ◽  
Icu Admission ◽  
Disease Outcomes ◽  
History Of ◽  
Stage Renal Disease

Abstract Background Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. Methods  This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. Results  A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08–1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07–1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07–1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01–1.55; p = 0.03) in fully adjusted models. Conclusion  Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

scholarly journals Incidence of acute kidney injury in bone marrow transplant patients; investigation of consequences within one to three years

2020 ◽  
Vol 10 (2) ◽  
pp. e10-e10
Author(s):  
Asieh Aref ◽  
Mohsen Maleknia ◽  
Alireza Nasrollahi ◽  
Abbas Hajifathali ◽  
Mahshid Mehdizadeh ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Allogeneic Transplant ◽  
Transplant Patients ◽  
Significant Difference ◽  
History Of ◽  
One Year ◽  
The One

Introduction: Previous studies have demonstrated that acute kidney injury (AKI) is a serious complication following hematopoietic stem cell transplantation (HSCT). The incidence of AKI in association with HSCT varies considerably because of several definitions for AKI. Objectives: In this study, we determined the rate of AKI after bone marrow transplantation (BMT) and its effects on patients’ outcomes according to modern definitions of AKI to conclude whether all these criteria can be useful for predicting AKI occurrence after BMT or not. Patients and Methods: We conducted a retrospective study of 271 patients undergoing HSCT, and after obtaining written informed consent from all patients, the required information was reviewed. AKI was defined according to RIFLE, KDIGO, and AKIN criteria. Renal function was assessed by calculating creatinine clearance, urine output, and estimated glomerular filtration rate (eGFR), determined through the MDRD equation. Results: Allogeneic and autologous transplantations were performed on 38 (14.02%) and 233 (85.97%) patients, respectively. According to the RIFLE criteria, 96 patients (35.42%) suffered from AKI, and based on AKIN, and KDIGO criteria, 101 patients (37.26%) were afflicted with it after BMT. The one-year mortality rate in allogeneic transplant patients with a history of AKI was 30.43% and 53.33% in patients without a history of AKI. The three-year mortality rate in allogeneic transplant patients with and without a history of AKI was 52.17% and 73.33% respectively, which showed no statistically significant difference. The three-year mortality rate in autologous transplant patients with and without a history of AKI was 60.27% and 22.5%, respectively. Conclusion: The one-year and three-year mortality rates, survival of patients, and AKI’s diagnosis were similar in all three criteria. Therefore, all these criteria can be useful for the prediction of AKI occurrence after BMT.

Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study

2019 ◽  
Vol 50 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Blaithin A. McMahon ◽  
Marie Galligan ◽  
Lynn Redahan ◽  
Terri Martin ◽  
Edel Meaney ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Urinary Ngal ◽  
Urinary Biomarker ◽  
Fatty Acid Binding ◽  
Entire Study ◽  
Clinical Model ◽  
Icu Admission ◽  
Group Evaluation

Background: The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective 2-center observational study investigating the utility of urinary biomarker combinations for the diagnostic and prognostic assessment of acute kidney injury (AKI) in a heterogeneous adult intensive care unit (ICU) population. The objective of this study is to evaluate whether serial urinary biomarker measurements, in combination with a simple clinical model, could improve biomarker performance in the diagnostic prediction of severe AKI and clinical outcomes such as death and need for renal replacement therapy (RRT). Methods: Urine was collected daily from patients admitted to the ICU, for a total of 7 post-admission days. Urine biomarker concentrations (neutrophil gelatinase-associated lipocalin [NGAL], α-glutathione S-transferase [GST], π-GST, kidney injury molecule-1 [KIM-1], liver-type fatty acid-binding protein [L-FABP], Cystatin C, creatinine, and albumin) were measured. Urine biomarkers were combined with a clinical prediction of AKI model, to determine ability to predict AKI (any stage, within 2 days or 7 days of ICU admission), or a ­30-day composite clinical outcome (RRT – or death). Results: A total of 257 (38%) patients developed AKI within 7 days of ICU admission. Of those who developed AKI, 106 (41%) patients met stage 3 AKI within 7 days of ICU admission and 208 patients of the entire study cohort (31%) met the composite clinical endpoint of in-hospital mortality or RRT within 30 days of ICU admission. The addition of urinary NGAL/albumin to the clinical model modestly improved the prediction of AKI, in particular severe stage 3 AKI (area under the curve [AUC] of 0.9 from 0.87, p = 0.369) and the prediction of 30-day RRT or death (AUC 0.83 from 0.79, p = 0.139). Conclusion: A clinical model incorporating severity of illness, patient demographics, and chronic illness with currently available clinical biomarkers of renal function was strongly predictive of development of AKI and associated clinical outcomes in a heterogeneous adult ICU population. The addition of urinary NGAL/albumin to this simple clinical model improved the prediction of severe AKI, need for RRT and death, but not at a statistically or clinically significant level, when compared to the clinical model alone.

scholarly journals Preventive strategies for acute kidney injury in cancer patients

2020 ◽  
Author(s):  
Laura Cosmai ◽  
Camillo Porta ◽  
Marina Foramitti ◽  
Valentina Perrone ◽  
Ludovica Mollica ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Clinical Approach ◽  
Related Risk ◽  
Threatening Condition ◽  
Huge Impact ◽  
Life Threatening ◽  
History Of

Abstract Acute kidney injury (AKI) is a common complication of cancer that occurs in up to 50% of neoplastic patients during the natural history of their disease; furthermore, it has a huge impact on key outcomes such as overall prognosis, length of hospitalization and costs. AKI in cancer patients has different causes, either patient-, tumour- or treatment-related. Patient-related risk factors for AKI are the same as in the general population, whereas tumour-related risk factors are represented by compression, obstruction, direct kidney infiltration from the tumour as well by precipitation, aggregation, crystallization or misfolding of paraprotein (as in the case of multiple myeloma). Finally, treatment-related risk factors are the most common observed in clinical practice and may present also with the feature of tumour lysis syndrome or thrombotic microangiopathies. In the absence of validated biomarkers, a multidisciplinary clinical approach that incorporates adequate assessment, use of appropriate preventive measures and early intervention is essential to reduce the incidence of this life-threatening condition in cancer patients.

scholarly journals Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

2020 ◽  
Vol 10 (4) ◽  
pp. 223-231 ◽  
Author(s):  
Jerald Pelayo ◽  
Kevin Bryan Lo ◽  
Ruchika Bhargav ◽  
Fahad Gul ◽  
Eric Peterson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
African American ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Hospital Death ◽  
City Hospital ◽  
History Of ◽  
Hospital Acquired

Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121–13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

scholarly journals MO406ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN HOSPITALIZED PATIENTS: A CROSS SECTIONAL STUDY FROM IRAN

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zohreh Rostami ◽  
Sepehr Shafei ◽  
Eghlim Nemati ◽  
Behzad Einollahi ◽  
Afsaneh Rostami
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Previous History ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Icu Admission ◽  
History Of

Abstract Background and Aims Acute kidney injury is an important finding in COVID-19 patients that can even result in renal replacement therapy. AKI complicates COVID-19 management by making volume management and administering agents with renal clearance challenging tasks. Various reasons have been proposed for the development of acute kidney injury in COVID-19 patients, including multi-organ failure and pre-renal causes, drug toxicity, tubular injury, and invasion of proximal tube podocytes by SARS-CoV-2. Although the development of AKI is not uncommon in COVID-19 patients, several inconsistencies in the literature exist regarding incidence rate and risk factors of acute kidney injury among hospitalized patients. This can be attributed to ethnical variations and methodological differences of studies. Herein we report AKI incidence in hospitalized COVID-19 patients in Baqiyatallah Hospital in Iran and investigate associate factors that can lead to AKI and renal replacement therapy in COVID-19 patients. Method In this cross-sectional study, we investigated medical records and laboratory data of hospitalized COVID-19 patients in Baqiyatallah Hospital in Tehran, Iran, from September 2020 until the end of November. COVID-19 infection was confirmed using polymerase chain reaction (PCR), and only patients with Positive PCR for COVID-19 were included. Furthermore, patients with missing data and unknown past medical history were excluded from this study, and a total of 459 patients were selected. The KDIGO criteria for acute kidney injury were used for evaluating kidney injury in COVID-19 patients. ICU admission and dialysis were according to the Ministry of Health and Medical Education on ICU admission and renal replacement therapy in COVID-19 patients. Results Of 459 patients with the criteria who were admitted to the hospital (244 male, 213 female, with an average age of 59.57 with SD 14.3), 75 patients (16%) developed acute kidney injury in the course of the disease. The mortality rate in patients with AKI (44%) was significantly higher than other patients (9%). The development of the AKI was significantly associated with the risk of ICU admission and the severe forms of the disease. Furthermore, it was observed that the patients who developed AKI was significantly older and male gender, diabetes (DM), Hypertension (HTN), and Previous history of Chronic kidney disease(CKD) was also significantly associated with developing AKI in COVID-19 patients. Chronic heart failure and ischemic heart disease increased the odds of developing AKI, but it was not significant enough to come up with a conclusion. It was observed that from 75 patients who developed AKI, 22 patients (29%) required renal replacement therapy. Of 22 patients who need dialysis, 14 patients did not survive (mortality rate=63%). The previous history of kidney disease increases the risk of dialysis due to AKI, while no significant association was found between age, gender, DM, HTN, and heart disease with the need for dialysis. Conclusion Results of our study indicate that acute kidney injury can be a major obstacle in managing COVID-19 patients. Patients with older age, previous history of CKD, HTN, and DM should be admitted to the hospital and monitored closely to prevent unfortunate outcomes of this disease.

P0606OUTCOME OF CANCER PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Suramath Isaranuwatchai ◽  
Supanat Worawichawong
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Advanced Stage ◽  
Significant Difference ◽  
The Difference ◽  
Advanced Stage Cancer

Abstract Background and Aims Recent advances in treatment of cancer lead to improvement in mortality among cancer patients. However, data regarding outcomes of cancer patients with acute kidney injury (AKI) requiring dialysis were scarce. We conducted this study to see the difference in mortality and other outcomes between cancer and non-cancer patients who had AKI requiring dialysis. Method We reviewed medical record of previous 18 months in our institute. Patients with age at least 18 years with acute kidney injury requiring dialysis were included in our study. Primary outcome was mortality at 30 days. Renal recovery and chronic kidney disease (CKD) after AKI events were also recorded. Results A total of 61 patients were included in our study; 28 patients had no cancer and 33 patients had cancer. Of cancer patients, 81.8% had advanced stage cancer. Modality of dialysis was continuous renal replacement therapy in 36.1%. Mortality at day 30 was not significantly different between cancer patients and non-cancer patients (57.6% vs. 53.6%, P = 0.754). Of alive patients, renal recovery among cancer patients and non-cancer patients was also not significantly different (69.2% vs. 50.0%, P = 0.310). CKD after episodes of AKI was also not significantly different between cancer patients and non-cancer patients (42.8% vs. 77.8%, P = 0.302). Conclusion This is the first study to compare mortality between cancer and non-cancer patients who had AKI requiring dialysis. We found no significant difference regard to mortality between AKI patients requiring dialysis with and without cancer. Renal recovery and CKD development were also not significantly different between two groups. More studies in nephro-oncology field are required for better treatment in cancer patients.

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