COVID-19 patients in intensive care develop predominantly oliguric acute kidney injury

Abstract

Background: Acute kidney injury (AKI) is a syndrome of reduced glomerular filtration rate and/or reduced urine flow associated with mortality in corona virus disease 2019 (COVID-19). AKI is often associated with renal tissue damage, which may lead to chronic kidney disease. Biomarkers of tissue damage may identify patients of particular risk.

Methods: In a prospective observational study of 57 patients admitted to intensive care, AKI incidence and characteristics was evaluated according to KDIGO criteria and related to days after admission. Urinary albumin, Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM-1) and Plasma Tissue Inhibitor of MetalloProteinase 2 (TIMP-2) were analysed in 52 patients at admission. The majority (n = 51, 89%) of patients developed AKI, and 27 (47%) patients had predominantly oliguric AKI where oliguria was more severe than plasma Creatinine increase. Severe oliguria within first 2 days after admission was common (n = 37, 65%), whereas stage 2 and 3 AKI due to Creatinine occurred later than day 2 in 67% (12/18) of cases. Renal replacement therapy was started in 9 (16%) patients, and 30-day mortality was 28%. Urinary biomarkers were increased in a majority of patients, but did not robustly predict KDIGO stage. Most patients had microalbuminuria, and severe albuminuria (albumin Creatinine ratio > 30 mg/mmol) was found in n = 9 (17%) patients.

Conclusions: A majority of patients with COVID-19 admitted to the ICU develop AKI. The functional deficit is often low urinary volume, and initial levels of biomarkers are generally increased without clear relation to final AKI stage.

Keywords: COVID-19; acute kidney injury; biomarkers; intensive care.

Figure 1

Flow chart detailing patient inclusion and analysis strata participation in a prospective observational study of acute kidney injury (AKI) incidence and biomarker profile in patients admitted with severe COVID‐19 in a tertiary ICU at a University Hospital in Sweden

Figure 2

Cumulative incidence of acute kidney injury (AKI) as proportion of patients without AKI according different criteria by different stages in relation to ICU Days in 57 patients included in a prospective observational study of AKI incidence and biomarker profile in patients admitted with severe COVID‐19 in a tertiary ICU at a University Hospital in Sweden. Proportions are illustrated according to classification by (A) combined KDIGO criteria (B) KDIGO Creatinine criteria only and (C) KDIGO Urine Output criteria only (N = 53)