Clinical Profile, Pharmacological Treatment, and Predictors of Death Among Hospitalized COVID-19 Patients With Acute Kidney Injury: A Population-Based Registry Analysis

Eduardo Gutiérrez-Abejón; Débora Martín-García; Eduardo Tamayo; F Javier Álvarez; Francisco Herrera-Gómez

doi:10.3389/fmed.2021.657977

Clinical Profile, Pharmacological Treatment, and Predictors of Death Among Hospitalized COVID-19 Patients With Acute Kidney Injury: A Population-Based Registry Analysis

Front Med (Lausanne). 2021 Jun 15:8:657977. doi: 10.3389/fmed.2021.657977. eCollection 2021.

Authors

Eduardo Gutiérrez-Abejón^{1

2}, Débora Martín-García³, Eduardo Tamayo^{4

5

6}, F Javier Álvarez^{1

4

7}, Francisco Herrera-Gómez^{1

4

8

9}

Affiliations

¹ Pharmacological Big Data Laboratory, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
² Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain.
³ Department of Nephrology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁴ BioCritic. Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain.
⁵ Department of Anaesthesiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁶ Department of Surgery, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
⁷ Comité de Ética de la Investigación con medicamentos, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁸ Unit of Kidney Resuscitation and Acute Purification Therapies, Hospital Virgen de la Concha, Zamora, Spain.
⁹ Transplantation Center, Lausanne University Hospital & University of Lausanne, Lausanne, Switzerland.

Abstract

Introduction: One of the worst clinical outcomes of the coronavirus disease 2019 (COVID-19) pandemic was acute kidney injury (AKI). Methods: This manuscript presents results from a population-based registry study assessing treatment, comorbidities, and predictors of hospital death among COVID-19 patients with AKI from March 1st to May 31th, 2020. Death, oxygen delivery and ventilation, acute dialysis need, use of medications, and various clinical outcomes, in addition to the length of stay in the hospital and intensive care unit (ICU), were evaluated. Results: In Castile and Leon, the largest region of Spain, 10.87% of the patients admitted for COVID-19 (n = 7,307) developed AKI. These patients were known by having hypertension (57.93%), cardiovascular disease (48.99%), diabetes (26.7%) and chronic kidney disease (14.36%), and they used antibiotics (90.43%), antimalarials (60.45%), steroids (48.61%), antivirals (33.38%), anti-systemic inflammatory response syndrome (SIRS) drugs (9.45%), and tocilizumab (8.31%). Mortality among patients with AKI doubled that observed in patients without AKI (46.1 vs. 21.79%). Predictors of hospital death in COVID-19 patients with AKI were ventilation needs (OR = 5.9), treatment with steroids (OR = 1.7) or anti-SIRS (OR = 2.4), severe acute respiratory syndrome (SARS) occurrence (OR = 2.8), and SIRS occurrence (OR = 2.5). Conclusions: Acute kidney injury is a frequent and serious complication among COVID-19 patients, with a very high mortality, that requires more attention by treating physicians, when prescribing medications, by looking for manifestations particular to the disease, such as SARS or SIRS.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; chronic kidney disease; mortality; treatment.