Department of Nephrology, Yashoda Hospitals, Secunderabad, India.
Department of Nephrology, Peshawar Institute of Cardiology, Peshawar, Pakistan.
BMC Nephrol. 2022 Sep 8;23(1):308. doi: 10.1186/s12882-022-02931-3.
Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital.
The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality.
A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality.
There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.
在严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）大流行的前两波中，急性肾损伤（AKI）在危重症患者中很常见。这些患者中有很大一部分需要肾脏替代治疗，并在医院死亡。
本研究检查了在印度和巴基斯坦的两个中心的 ICU 中收治的 AKI 危重症患者的临床表现、实验室参数和治疗干预措施。收集了所有需要肾脏替代治疗的 ICU 中 COVID-19 危重症患者的患者和结局详细信息。分析数据以检测与死亡率相关的患者变量。
共有 1714 名危重症患者被收入这两个中心的 ICU。其中 393 名（22.9%）患有严重急性肾损伤（AKIN 第 3 期）需要透析。其中，60.5%为男性，平均（±标准差）年龄为 58.78（±14.4）岁。在开始透析时，346 名患者（88%）为少尿型。这些患者最常见的透析方式是间歇性血液透析（48.1%），其次是缓慢低效透析（44.5%）。206 名（52.4%）患者死亡。印度队列的死亡率（68.1%）高于巴基斯坦队列（43.4%）。年龄较大（年龄>50 岁）、低血清白蛋白、意识改变、需要更缓慢的肾脏替代治疗形式和通气支持与死亡率独立相关。
在该亚组队列的 ICU 中，接受肾脏替代治疗的 COVID-19 相关 AKI 患者死亡率非常高。
