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. 2022 Oct 18;11(20):6130.
doi: 10.3390/jcm11206130.

Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19

Mickaël Bobot  1   2   3 , David Tonon  4 , Noémie Peres  3 , Christophe Guervilly  3 , Flora Lefèvre  1 , Howard Max  5 , Youri Bommel  5 , Maxime Volff  5 , Marc Leone  6 , Alexandre Lopez  6 , Pierre Simeone  5   7 , Julien Carvelli  8 , Sophie Chopinet  9   10 , Sami Hraiech  3 , Laurent Papazian  3 , Lionel Velly  5   7 , Jérémy Bourenne  8 , Jean-Marie Forel  3 ; GRAM+ (Groupe de Recherche en Réanimation et Anesthésie deMarseille)
Affiliations

Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19

Mickaël Bobot et al. J Clin Med. .

Abstract

Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307−13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044−1.241), p = 0.003) and iNO (OR: 5.694 (1.953−16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057−0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053−0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.

Keywords: ARDS; COVID-19; acute kidney injury; dexamethasone; inhaled nitric oxide; intensive care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study. AKI: Acute Kidney Injury, CKD: Chronic Kidney disease, ICU: Intensive Care Unit, RRT: Renal replacement therapy.
See this image and copyright information in PMC

References

    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., Wu Y., Zhang L., Yu Z., Fang M., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir. Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Gabarre P., Dumas G., Dupont T., Darmon M., Azoulay E., Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46:1339–1348. doi: 10.1007/s00134-020-06153-9. - DOI - PMC - PubMed
    1. Pei G., Zhang Z., Peng J., Liu L., Zhang C., Yu C., Ma Z., Huang Y., Liu W., Yao Y., et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J. Am. Soc. Nephrol. 2020;31:1157–1165. doi: 10.1681/ASN.2020030276. - DOI - PMC - PubMed
    1. Burtey S., Sallée M. Kidney damage in COVID-19. Nephrol. Ther. 2021;17:203–207. doi: 10.1016/j.nephro.2021.06.002. - DOI - PMC - PubMed
    1. Ferlicot S., Jamme M., Gaillard F., Oniszczuk J., Couturier A., May O., Grünenwald A., Sannier A., Moktefi A., Le Monnier O., et al. The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria. Nephrol. Dial. Transplant. Off. Publ. Eur. Dial. Transpl. Assoc.—Eur. Ren. Assoc. 2021;36:1253–1262. doi: 10.1093/ndt/gfab042. - DOI - PMC - PubMed

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