Characterisation of Acute Kidney Injury in Critically Ill Patients with Severe Coronavirus Disease-2019 (COVID-19)

  1. Sébastien Rubin
  2. Arthur Orieux
  3. Renaud Prevel
  4. Antoine Garric
  5. Marie-Lise Bats
  6. Sandrine Dabernat
  7. Fabrice Camou
  8. Olivier Guisset
  9. Nahema Issa
  10. Gaelle Mourissoux
  11. Antoine Dewitte
  12. Olivier Joannes-Boyau
  13. Catherine Fleureau
  14. Hadrien Rozé
  15. Cédric Carrié
  16. Laurent Petit
  17. Benjamin Clouzeau
  18. Charline Sazio
  19. Hoang-Nam Bui
  20. Odile Pillet
  21. Claire Rigothier
  22. Frederic Vargas
  23. Christian Combe
  24. Didier Gruson
  25. Alexandre Boyer

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Abstract

Background

COVID-19-associated acute kidney injury frequency, severity and characterisation in critically ill patients has not been reported.

Methods

Single-center cohort performed from March 3, 2020, to April 14, 2020 in 4 intensive care units in Bordeaux University Hospital, France. All patients with COVID19 and pulmonary severity criteria were included. AKI was defined using KDIGO criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterisation (transient vs. persistent acute kidney injury; proteinuria, hematuria and glycosuria), and short-term outcomes was evaluated.

Results

71 patients were included, with basal serum creatinine of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median follow-up was 17 [12–23] days. AKI developed in a total of 57/71 (80%) patients with 35% Stage 1, 35% Stage 2, and 30% Stage 3 acute kidney injury; 10/57 (18%) required renal replacement therapy. Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median urine protein/creatinine of 82 [54–140] (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20 indicating predominant tubulo-interstitial injury. Only 2 (4%) patients had glycosuria. At Day 7 onset of after AKI, six (11%) patients remained dependent on renal replacement therapy, nine (16%) had SCr > 200 µmol/L, and four (7%) died. Day 7 and day 14 renal recovery occurred in 28% and 52 % respectively.

Conclusion

COVID-19-associated AKI is frequent, persistent severe and characterised by an almost exclusive tubulo-interstitial injury without glycosuria.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.06.20069872: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study obtained the approval of the Institutional Review Board of the University Hospital of Bordeaux (declaration number 2020–14).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of our work includes the small number of patients (n=71) and a limited median follow-up period (2 weeks). These results will have to be confirmed by larger studies with longer follow-up period. In conclusion, this study should make physicians aware of the likely existence of a frequent, severe and specific COVID19-associated AKI. The study provides additional insights into the characterisation of AKI: a tubulo-interstitial injury without glycosuria. Further work should be carried out promptly in order to identify and assess specific therapeutic options.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.06.20069872v1 on medRxiv