Acute kidney injury and COVID-19 in young adults in intensive care

This is a retrospective, quantitative and analytical study. The sample consisted of young adults (20 to 40 years old) admitted to Intensive Care Units, diagnosed with SARS-CoV-2 infection between March and December 2020. Data were obtained through electronic medical records, and kidney injury acute was defined by the creatinine value, according to the Kidney Disease Improving Global Outcomes guidelines criteria. Statistical significance was p≤0.05.

Results

A total of 58 young adults were hospitalized, 63.8% of whom were male. Hypertension was present in 39.6%, obesity in 18.9%, and diabetes mellitus in 8.6%. Acute kidney injury was identified in 55.1%, with stage 3 predominating in 43.1% of them. In these patients, the use of mechanical ventilation and vasoactive drugs was significant in 92% as well as respiratory organ dysfunction (80%), followed by renal organ dysfunction (76%). Risk factors such as kidney transplantation or chronic kidney disease and obesity increased by 12.3 and 9.0 times, respectively, the chances of developing acute kidney injury.

Conclusion

This study demonstrated a high kidney injury prevalence in young adults and its association with previous comorbidities. Obesity, kidney transplantation and chronic kidney disease increased the chance of young adults to develop acute kidney injury, resulting in outcomes in favor of morbidity and mortality.

Acute kidney injury; COVID-19; Coronavirus infections; SARS-CoV-2; Young adult; Respiration, artificial; Intensive care units

Variables	Without AKI (n=26)	With AKI (n=32)			p-value
Variables	Without AKI (n=26)	KDIGO 1(n=2)	KDIGO 2 (n=5)	KDIGO 3 (n=25)	p-value
Age	32.65±5.35	30.00±8.48	37.20±0.83	33.96±5.65	0.257*
Sex
Male	61.5	50	80	64	0.920^†
Female	38.4	50	20	36	0.920^†
Ethnicity/color
White	53.8		80	52
Brown	30.7	50	20	40	0.920^†
Black	15.3	50		8
Comorbidities
Yes	69.2	50	100	90	0.010^†
No	26.9			4	0.050^†
Hypertension	11.5	50	60	60	0.080^†
DM	7.6		20	8	0.670^†
Obesity	11.5	0	20	28	0.002^†
Origin
Emergency room	61.5	50	80	64	0.920^†
Inpatient unit	38.4	50	20	36	0.920^†
Outcome
Discharge	88.4	50	60	60	0.050^†
Death	11.5	50	40	40	0.050^†

Variables	Without AKI (n=26)	With AKI (n=32)			p-value
Variables	Without AKI (n=26)	KDIGO 1 (n=2)	KDIGO 2 (n=5)	KDIGO 3 (n=25)	p-value
Used mechanical ventilation	42.3	50	60	92	<0.001
Norepinephrine	46.1	50	60	92	0.008
Vasopressin	7.6	50	20	40	0.021
Corticosteroid	50	50	60	88	0.011
Sepsis	42.3	100	40	80	<0.001
Respiratory organ dysfunction	30.7	50	40	80	<0.001
Hematologic organ dysfunction	15.3	50	20	24	0.515
Kidney organ dysfunction	15.3	50	20	76	<0.001
RRT	7.6	50	20	80	<0.001
Conventional hemodialysis	7.6	50	20	88	<0.001
Serum creatinine, mg/dL	0.87± 0.61	1.24 ±0.30	2.32 ±0.36	5.24± 1.97	<0.001*
Serum urea, mg/dL	41.62±32.37	75±82.02	70.60±34.70	93.76±52.70	0.001*
CRP, mg/dL	127.42±118.69	208.69±149.86	188.26±80.58	167.74±130.45	0.500*
Lymphocytes, U/mm³	1.292.80±656.19	2.064±62.22	481.40±274.73	1.202.16±589.97	0.012^†
D-dimer, mg/dL	2.56±3.33	9.36±6.71	0.84±0.31	3.96±4.60	0.036*
LDH, UI/L	525.9±367.67	777.5±74.24	432.33±323.70	577.73±423.55	0.415*
Lactate, mg/dL	23.31±44.24	28.5±23.33	14.40±3.78	13.78±7.86	0.527*
pH	7.38±0.14	7.32±0.01	7.39±0.08	7.35±0.09	0.042*
PaO2, mmHg	73.18±33.14	74.10±13.01	83.06±39.52	95.46±31.40	0.044*
PaCO2, mmHg	43.67±29.30	34.15±0.91	36.26±6.12	35.40±13.96	0.698*
HCO3, mmol/L	21.71±5.41	17.45±0.07	22.44±4.10	18.88±5.96	0.026*
Urinary volume, mL/24hours	1.575±537.05	1.297±710.64	2.050±859.26	723.18±938.36	0.008*

Variables	OR*	95%CI	p-value^†
Kidney transplantation or chronic kidney disease	12.3	(2.8 - 63.8)	0.001
Hypertension	3.4	(0.9 - 13.9)	0.069
Obesity	9.1	(1.9 - 52.1)	0.008

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author Cassiane Dezoti da Fonseca E-mail: cassiane.dezoti@unifesp.br