Salgueira Mercedes, Almenara Marina, Gutierrez-Pizarraya Antonio, Belmar Lara, Labrador Pedro Jesús, Melero Rosa, Serrano María Luisa, Portolés José María, Molina Alicia, Poch Esteban, Ramos Natalia, Lloret María Jesús, Echarri Rocío, Díaz Mancebo Raquel, González-Lara Diego Mauricio, Sánchez Jesús Emilio, Soler María José
Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España.
Unidad de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España.
Nefrologia. 2023 Apr 6. doi: 10.1016/j.nefro.2023.03.008.
Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed.
In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality.
Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time ( < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).
Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
急性肾损伤（AKI）在新冠肺炎住院患者中很常见，且与较差的预后相关。西班牙肾脏病学会创建了AKI-COVID注册登记系统，以描述西班牙医院中因新冠肺炎住院且发生AKI的患者群体。评估了这些患者对肾脏替代治疗（RRT）治疗方式的需求及死亡率。
在一项回顾性研究中，我们分析了AKI-COVID注册登记系统的数据，该系统纳入了2020年5月至2021年11月在西班牙30家医院住院的患者。记录了临床和人口统计学变量、与新冠肺炎和AKI严重程度相关的因素以及生存数据。进行多因素回归分析以研究与RRT和死亡率相关的因素。
记录了730例患者的数据。其中71.9%为男性，平均年龄70岁（60 - 78岁），70.1%患有高血压，32.9%患有糖尿病，33.3%患有心血管疾病，23.9%患有某种程度的慢性肾脏病（CKD）。94.6%的患者被诊断为肺炎，54.2%的患者需要通气支持，44.1%的患者入住重症监护病房（ICU）。从新冠肺炎症状出现到AKI出现的中位时间（37.1%为KDIGO 1期，18.3%为KDIGO 2期，44.6%为KDIGO 3期）为6天（4 - 10天）。共有235例（33.9%）患者需要RRT：155例接受持续肾脏替代治疗，89例隔日透析，36例每日透析，24例延长血液透析，17例接受血液滤过治疗。吸烟习惯（比值比[OR] 3.41）、通气支持（OR 20.2）、最高肌酐值（OR 2.41）和AKI发病时间（OR 1.13）是RRT需求的预测因素；年龄是保护因素（0.95）。未接受RRT的患者群体特点为年龄较大、AKI较轻、肾脏损伤发病和恢复时间较短（P < 0.05）。38.6%的患者在住院期间死亡；死亡组中严重AKI和RRT更为常见。在多因素分析中，年龄（OR 1.03）、既往慢性肾脏病（OR 2.21）、肺炎的发生（OR 2.89）、通气支持（OR 3.34）和RRT（OR 2.28）是死亡率的预测因素，而ARB长期治疗被确定为保护因素（OR 0.55）。
新冠肺炎住院期间发生AKI的患者平均年龄较高，合并多种疾病且感染严重我们定义了两种不同的临床模式：一种是发病早的AKI，见于老年患者，数天内可缓解，无需RRT；另一种是更严重的模式，对RRT需求更大，发病晚，与传染病的更严重程度相关。感染的严重程度、年龄和入院前CKD的存在被确定为这些患者死亡的危险因素。此外，ARB长期治疗被确定为死亡率的保护因素。
