Early COVID-related Acute Kidney Injury Recovery May Course with Hydroelectrolytic Disorders in Patients With High Risk of Insensible Fluid Loss

  1. Géssica Sabrine Braga Barbosa
  2. Ana Gabriela de Jesus Torres de Melo
  3. Rayra Gomes Ribeiro
  4. Daniela del Pilar Via Reque Cortes
  5. Carla Paulina Sandoval Cabrera
  6. Rubens Santos Andrade Filho
  7. Guilherme Tamborra Pantaroto
  8. Bruno de Castro Paul Schultze
  9. Gilberto Alvarenga Paula
  10. Camila Eleuterio Rodrigues

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Abstract

Background

Acute Kidney Injury (AKI) may occur in more than 30% of COVID hospitalized patients, and renal recovery is poorly described.

Aim

We aimed to evaluate the renal short-term recovery profile of COVID-related AKI (COV+) compared to COVID-unrelated AKI (COV-).

Design

case-control retrospective single-center study

Methods

All patients admitted to the Hospital das Clínicas, University of São Paulo, who recovered AKI from April to June of 2020 (COV+, n=98) and from August to October of 2019 (COV-, n=50) were analyzed. Recovery was defined by spontaneous serum creatinine drop or withdrawal of dialysis. Serum electrolytes were analyzed during the first five days of recovery.

Results

Among 333 COV+ patients, 98 recovered from AKI (29.4%), while 50 of 177 COV-patients recovered (28.2%). The COV- group presented higher prevalence of chronic morbidities, while the COV+ group had a worse acute clinical course requiring vasoactive drugs (VAD), mechanical ventilation (MV) and dialysis. COVID-19 diagnosis was associated with need of mecxhanical ventilation, dialysis, presence of fever, and higher use of any diuretic drug during first days of recovery. The presence of fever and mechanical ventilation were the predictors associated with intravascular volume depletion surrogates (daily progressive rising in sodium levels and elevation in serum urea: creatinine ratio). Neither COVID-19 nor diuretics use seem to be independent risk factors for this.

Conclusions

Intravascular volume depletion surrogates are more common in short-term AKI-recovery of patients presenting fever and mechanical ventilation, commons features in SARS-CoV2 infection.

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  1. ScreenIT

    SciScore for 10.1101/2021.10.20.21265300: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethical Aspects: The study was approved by the local institutional review board (Reference no. 4.112.403), and it is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement (8).
    Sex as a biological variableKidney transplant recipients and pregnant woman were not considered for the purpose of this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis were performed using GraphPad Prism, version 5.0 for Windows, R statistical software, version 4.0.5 and Rstudio, version 1.4.1106 (R Development Core Team, 2020).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Rstudio
    suggested: (RStudio, RRID:SCR_000432)
    R Development Core
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We recognize that our study has some important limitations, mainly regarding the low number of patients, the unicentric experience, and the retrospective design. Also, the impossibility to consider the fluid balance of patients certainly impaired the real volume depletion analysis that would be ideally done. However, to our knowledge this is the first study that recalls some attention to the possibility of hydroelectrolytic disorders in patients who are recovering from AKI in COVID-19 patients, and we believe that this concern needs to exist when caring of patients with potential risk of insensible fluid loss.

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.10.20.21265300v1 on medRxiv