World Journal of
Pharmaceutical and Life Sciences

ACUTE KIDNEY INJURY IN HOSPITALIZED COVID-19 PATIENTS: ETIOLOGY, RISK FACTORS AND OUTCOME

Prof. Dr. Nazneen Mahmood*, Prof. Dr. M. R. Hassan, Dr. MMR Siddiqui, Dr. R. S. Giasuddin, Dr. M. A. Rashid, Dr. S. H. Bhuiyan and Dr. A. A. Imran

ABSTRACT

Acute Kidney Injury (AKI) is now recognized as a common complication of COVID-19. As with AKI from other causes, COVID-19-associated AKI (COVID-19 AKI) is associated with adverse outcomes, including the development or worsening of comorbid disease as well as greater use of health-care resources. The aim of the present study is to assess the risk factors and outcome of hospitalized Covid 19 patients who developed AKI, thus reduce the morbidity and mortality of these patients. This is a Cross Sectional Descriptive type of Observational study on patients of AKI admitted to Covid Unit (CU) of AKMMCH. Duration of the study was 6 months. Inclusion criteria- Adult population 18-95 years, both male and female, patients of ICU (Intensive Care Unit), suffering from AKI who fulfills the RIFLE criteria, patients with sign symptoms of COVID-19, both RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) for COVID-19 positive and negative cases with raised inflammatory markers and HRCT (High Resolution Computed Tomography) chest shows peripheral ground glass shadows suggestive of COVID. Age below 18 years, patients with Chronic Kidney Disease (CKD) on maintenance hemodialysis (MHD), or on peritoneal dialysis (PD) or with renal transplant were excluded from the study. A total number of 212 patients were included in the study. Among them 113 (53.3%) were male and 99 (46.7%) were female, M:F was 1.14:1. Mean age (Mean ±SD) of the patients was 63.06±13.14 (Age Range 18-95 years). Most of the patients, 33.78% (68) from age group 61-70 years. Next to which were age group 51-60 years, 54 (25.47%) and 71-80 years, 47 (22.27%). Most of the patients were suffering from Hypertension (HTN) 79.25% (168). Next to which was Diabetes mellitus (DM) 59.43% (126). 56.13% (119) patients were of both HTN and DM. 161 (75.94%) patients were of RT PCR for Covid-19 positive and 24.06% (51) were negative whereas all of the patients were symptomatic with HRCT chest showed Covid pneumonia. HRCT chest showed 32.55% (69) patients had 26-50% lung involvement and 63(29.72%) were of 51-75%. Mean values of important biochemical markers were Serum Creatinine 3.56±2.75 mg/dl, Blood Urea 108.81±72.89 mg/dl, HbA1C (Glycated hemoglobin) 7.9±2.32%, C Reactive Protein (CRP) 80.67±86.20 mg/L, D-Dimer 1.77±2.21mg/L, LDH (Lactate dehydrogenase) 397.73±227.59 U/L, IL-6(Interleukin-6) 211.48±950.78 pg/ml and Serum Ferritin 1092.14±1622.98 ng/ml. 74.06% (157) patients were admitted to cabin and 3.77% (8) and 22.17% (47) admitted to HDU and ICU respectively. Mortality rate was 27.03% in cabin, 13.51% in HDU and 59.46% in ICU. The distribution of patients according to the Stages of AKI, 37.26% (79) patients were of Stage 1, 31.13% (66) Stage 2 and 31.60% (67) patients were of Stage 3 AKI. 7.08% (15) of Stage 3 AKI (22.79% of all patients) needed Hemodialysis (Sustained low efficacy dialysis-SLED). All of the patients received Antiviral and Anticoagulant drugs. 87.26% (185) patients were treated with Monoclonal antibodies and 15 (7.08%) patients needed Hemodialysis. 174 (82.08%) patients recovered and 37 (17.45%) patients died and 1 patient took DORB and shifted to other hospital. We came to know that, most of the patients who developed AKI after COVID-19, were of older age group, mostly males with co morbidities (Hypertension and DM) with lung involvement 50%. So older age, male patients, co morbidities were the risk factors of developing AKI in COVID-19. All of them had high inflammatory markers. One fourth of the patients of Stage 3 AKI needed hemodialysis and mortality rate was high in ICU. These data provide robust evidence to support the patients with COVID-19 who should be closely monitored for the development of AKI and measures taken to prevent this, though further studies are required to determine the most effective clinical approach.

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