key: cord-0776923-s90qrxw5
authors: ARROCHA LUCANA, G. G.; Casas, R.
title: POS-003 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS WITH COVID-19 EXPERIENCE OF A ICU BOLIVIAN CENTER REFERENCE
date: 2021-04-30
journal: Kidney International Reports
DOI: 10.1016/j.ekir.2021.03.009
sha: d43fecab994e1ceaed67ac1ee117e1438c102ede
doc_id: 776923
cord_uid: s90qrxw5

nan

Introduction: In critically ill patients, septic shock is one of the major causes of acute kidney injury (AKI) in more than 40% of patients in the intensive care unit (ICU). About 70% of patients with AKI require renal replacement therapy (RRT), and in-hospital mortality is more than 60%. The initiation time of CRRT, The concept of 'optimal timing' in CRRT initiation has no clear consensus, and the terms 'early' and 'late' CRRT initiation are widely defined in previous studies; the development of clinical manifestations and complications of renal insufficiency, the requirement of inotropic drugs, and blood urea nitrogen (BUN) levels are indiscriminate in some patients. Methods: We did a retrospective analysis of all patient admitted to ICU between 2018 to 2020 and suffered acute kidney injury requiring renal replacement therapy. We investigated the time from AKI onset to CRRT initiation influence on the survival of critically ill patients, The relationship between normalization of renal parameters by CRRT and critical patient outcome. We excluded individuals who had recovered kidney function or died shortly after CRRT initiation, as well as those who had only one CRRT session. A CRRT session was defined as an individual treatment with CRRT for at least a 24-hour period during which CRRT was prescribed. For each patient, we included up to the first three CRRT sessions. Our data included demographic information, the reason for ICU admission, and Charlson comorbidity scores on the day of CRRT initiation. Bloodwork was done on the day of admission to the hospital, transfer to ICU, and on the day of CRRT initiation. Systolic and diastolic blood pressure and vasopressor requirements. We compared continuous variables using analysis of variance and categorical variables compared using the Fisher exact test. We evaluated the relationship between CRRT modality (SLED vs CRRT) and hemodynamic instability using generalized estimating equations, in order to account for intra-patient clustering associated with the receipt of repeated CRRT sessions. Multivariable models were adjusted for age, gender, Charlson score, ICU type, SOFA score at CRRT initiation, baseline estimated GFR, and vasopressor requirement prior to CRRT initiation. Results: We had 110 patients received 409 CRRT sessions, the patient started the CRRT in the first 6 hours post declaration of acute kidney injury performed in a better way for recovery compared to those that started late. Late initiation of CRTT associated with prolonged treatment time for than 72 hours. Mortality in ICU is multifactorial with poor correlation to the modality of CRRT. Serum and biomarkers and fluid balance constitute the most important landmarks for planning the duration of CRRT. Conclusions: CRRT is essential in critical care management of patients with acute kidney injury, optimal initiation, and termination timing is critical for patient and kidney survival.

No conflict of interest Introduction: Mesoamerican nephropathy (MN) is a chronic tubuleinterstitial nephropathy, originally described in Central America, and whose etiology is still unknown. Among its many proposed inducing factors are severe dehydration, rhabdomyolysis, nephrotoxicity, chronic infections, genetic predisposition, etc. However, clinical cases similar to MN have been described in other geographically distant and ethnically diverse regions which have a common factor: the intensity of heat and rural physical labor. For this reason, we suggest the term "agricultural nephropathy" as more appropriate name for this condition. Then, it was decided to study whether this entity could occur among rural workers in a non Mesoamerican region but having similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repeated dehydration could weigh in its pathogenesis. Introduction: Acute kidney injury (AKI) is a disease of diverse etiology, consisting of a decrease in the glomerular filtration rate and therefore with the retention of waste products such as urea and creatinine, accompanied by fluid, electrolyte and acid-base disorders. It is present in 39.5% of the cases admitted to intensive care unit (ICU) in our hospital, it affects mainly men with infectious processes, impacting mortality. Hypoalbuminemia has been associated with positive fluid balances, however there are few studies that attempt to associate it with AKI.

Methods: Case-control study, including patients admitted to ICU at Hospital Central Sur de Alta Especialidad (HCSAE) in Mexico City with serum albumin determination at admittance. The cases were distributed into a control group (normoalbuminemia >3.5 g/dl) and the studied group (hypoalbuminemia <3.5 g/dl). Patients on hemodialysis, peritoneal dialysis, kidney transplant, burned patients, fed by parental nutrition, and patients with liver failure were excluded. Those patients who presented two AKI events in less than 7 days were eliminated.

Statistical analysis was carried out using SPSS software, version 20 (SPSS, Inc., Chicago, IL). A t-test and one-way ANOVA were used for analysis of normally distributed data. Categorical data were compared using a Pearson chi-squared test or Fisher's exact test. Data that were not normally distributed were analyzed using a Mann-Whitney U test, Wilcoxon signed-rank test, and Kruskal-Wallis test. Continuous variables were described using mean standard deviation or median with interquartile range (IQR). P values # 0.05 were considered to represent statistically significant differences. The primary outcome was to determine whether hypoalbuminemia is associated with development of AKI in patients admitted to ICU. Results: 197 patients were included, 174 in the group to study and 23 for the control group; men (51%) ,median age was 71 (+17.41) years. Mortality predominated in the study group with 160 (92%) vs 16 (69.6%) for the control (p <0.005). The outcome of AKI was more frequent in patients with hypoalbuminemia with 122 (70.1%) cases compared to the control (39.1%) and OR 3.01 [95% ; p = 0.004),septic shock with was present in 54% in patients with hypoalbuminemia (p <0.0001). Introduction: COVID-19 is an infectious disease caused by the novel coronavirus SARS-CoV-2. Most of the patients experience mild to moderate disease. It mainly affects the respiratory tract but other organs may be involved especially the kidney. The incidence of acute kidney injury (AKI) in patients with COVID-19 is not well described in Sub-Saharan Africa. We assessed the incidence and clinical characteristics of COVID-19 patients developing AKI in a critical care unit at a private hospital.

Methods: This was a retrospective observational survey of all patients admitted to the Critical Care Unit of a private hospital in Nairobi, Kenya, with laboratory confirmed COVID-19. The study period was from March to August 2020. Data regarding the clinical characteristics of patients, clinical course during admission and outcomes were obtained from the medical records. Acute kidney injury was defined as per the KDIGO clinical guidelines using serum creatinine and urine output.

Results: A total of 41 patients were admitted to the Critical Care Unit between March to August 2020. 10 (24.4%) patients developed acute kidney injury. 8 (80%) were males and 2 (20%) were females. The mean age of the patients who developed AKI was 57.7 years while the median age was 58.5 years. 6 (60%) of the patients who developed AKI were aged between 40 to 60 years while 4 (40%) of the patients were older than 60 years. Majority of the patients (90%) had pre-existing diabetes mellitus and systemic arterial hypertension. 4 (40%) of the patients with AKI required renal replacement therapy. 2 (20%) of the patients still required RRT on discharge. 7 (70%) patients had complete resolution of the acute kidney injury. The mortality was 50% (5 patients) in patients who had AKI. 

United States, 3 Indiana University School of Medicine, Department of Pediatrics Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis, United States, 4 Makerere University, Department of Paediatrics and Child Health

Introduction: There are limited data on the epidemiology of acute kidney injury (AKI) in children with sickle cell anemia (SCA) from low-income settings. We evaluated the incidence and clinical correlates of AKI among Ugandan children hospitalised with vaso-occlusive crises (VOC). Methods: We prospectively enrolled 185 Ugandan children with SCA 2 to 18 years of age admitted with VOC and age-matched controls in steady state. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. A large proportion of children had low creatinine levels most likely due to hyperfiltration, we thus defined AKI based on two approaches. The first approach (original-KDIGO) defined AKI based on a $1.5-fold change in creatinine within seven days or an absolute change of $ 0.3mg/dl within 48 hours. The second approach (modified-KDIGO) excluded children with creatinine 1.5-fold change of from 0.2mg/dL to 0.3mg/dL. Creatinine was measured using an enzymatic assay with amperometric detection using the handheld iSTAT blood analyzer and CHEM8+ cartridges. Results: Using the original-KDIGO definition of AKI, 89 children (48.1%) had AKI over hospitalization with 71 cases (38.4%) present on admission, and 18 children (9.7%) developed incident AKI during hospitalization. Of those with AKI, 39 cases occurred in children with a baseline value of 0.2mg/dL with a 1.5-fold increase to 0.3m/dL. By the modified KDIGO-definition, 50 children (27.0%) had AKI over hospitalization with 40 cases (21.6%) present on admission, and 10 children (5.4%) developing incident AKI during hospitalization. We used serum Cystatin C as an alternative filtration biomarker to evaluate the original and modified-KDIGO approaches in diagnosis of AKI. Using the modified-KDIGO definition, Cystatin C had a higher area under receiver operating characteristic curve (AUROC) compared to the original-KDIGO definition for AKI suggesting better discrimination. The modified-KDIGO definition was associated with more pronounced proteinuria and elevated urine NGAL levels. Thus subsequent analyses were conducted using the modified definition. Using multivariable logistic regression analysis, independent risk factors for AKI were female