Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course

  1. Raúl Lombardi
  2. Alejandro Ferreiro
  3. Daniela Ponce
  4. Rolando Claure-Del Granado
  5. Gustavo Aroca
  6. Yanissa Venegas
  7. Mariana Pereira
  8. Jonathan Chavez-Iñiguez
  9. Nelson Rojas
  10. Ana Villa
  11. Marcos Colombo
  12. Cristina Carlino
  13. Caio Guimarâes
  14. Mauricio Younes-Ibrahim
  15. Lilia Maria Rizo
  16. Gisselle Guzmán
  17. Carlos Varela
  18. Guillermo Rosa-Diez
  19. Diego Janiques
  20. Roger Ayala
  21. Galo Coronel
  22. Eric Roessler
  23. Serena Amor
  24. Washington Osorio
  25. Natalia Rivas
  26. Benedito Pereira
  27. Caroline de Azevedo
  28. Adriana Flores
  29. José Ubillo
  30. Julieta Raño
  31. Luis Yu
  32. Emmanuel A. Burdmann
  33. Luis Rodríguez
  34. Gianny Galagarza-Gutiérrez
  35. Jesús Curitomay-Cruz

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Abstract

The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54–74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course.

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  1. Version published to 10.1371/journal.pone.0261764
  2. ScreenIT

    SciScore for 10.1101/2021.05.01.21256389: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Bioethical considerations: the Institutional Review Board of the Clínica Los Olivos, Cochabamba, Bolivia (contact Dr. Esdenka Vega, administracion(at)clinicalosolivos.
    Consent: The informed consent was considered not mandatory by the reference IRB given the observational characteristic of the study.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The statistical package IBM SPSS Statistics Base version 22 NY, USA, was used for data processing and for statistical analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    With these limitations, we identified nine variables that were independently associated to in-hospital mortality. Older age (OR 0.96, 95% IC 0.94-0.99); heart disease (OR 2.87, 95% IC 1.14-7.19); fluid depletion (OR 2.18, 95% IC 1.08-4.42) and COVID-19 MODS (OR 2.21, 95% IC 1.05-4.65) as cause of AKI; non-recovery of renal function (OR 31.72, 95% IC 15.46-65.08); critically ill condition (OR 38.54, 95% IC 11.86-125.17); use of vasopressor (OR 3.95, 95% IC 1.51-10.32); some in-hospital complications (OR 3.30, 95% IC 1.42-7.79) and hospital length-of-stay (OR 1.05, 95% IC 1.02-1.07). Of note, sCr requested at three time points (admission, peak, discharge) did not enter in the model. Our study has some limitations. First, its design as a repository of patients promote the individual participation in addition to that of institutions, as desired. In return, entail some heterogeneity in the quality of information resulting in some variables having a high proportion of missing data that forced us to exclude them from the analysis. Consequently, potential unmeasured confounder may not have been identified. Second, the limited ability to access the universe of millions patients did not allow us to establish incidence, which is a very relevant information, particularly considering that is a controversial and open point. Third, data of patients was provided by the participants and not as a result of the review of clinical charts by the research team. We also acknowledge some strengths. ...

    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.
    • No funding statement was detected.
    • No protocol registration statement was detected.

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

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  3. Version published to 10.1101/2021.05.01.21256389v1 on medRxiv