By the bioMérieux Connection Editors
One of the most severe and potentially life-threatening complications of COVID-19 is organ failure, and Acute Kidney Injury (AKI) in particular. As the COVID-19 pandemic continues, so do the efforts to improve patient treatment related to Acute Kidney Injury (AKI).
AKI is a sudden episode of kidney failure or kidney damage that causes a build-up of waste products in the bloodstream and makes it hard for your kidneys to keep the right balance of fluid in your body. In serious cases, Renal Replacement Therapy (RRT) is needed to supplement and/or replace the normal blood-filtering function of the kidneys. The most common form of RRT is dialysis but can also include solutions like kidney transplantation.
A Dire Situation
Patients with COVID-19 have a high variability of symptoms ranging from asymptomatic to critical illness. In the beginning stages of COVID-19, reports indicated that the occurrence of AKI in COVID-19 patients was negligible. However, growing evidence shows that AKI is prevalent among COVID-19 patients, especially those in the ICU. A report from the National Kidney Foundation found that, “patients hospitalized with COVID-19 are twice as likely to develop AKI as compared to non-COVID patients who developed AKI during the same time period.”
To illustrate the severity and implications of AKI among COVID-19 patients, one study conducted at Mount Sinai Health System from February 27 to May 30, 2020, found that, “In-hospital mortality was 50% among patients with AKI.” Another study conducted at Kaiser Permanente Los Angeles Medical Center from March 14 to September 30, 2020 found “68% mortality rate among COVID-19 patients with AKI requiring RRT.”
Turning the Corner
As the pandemic has progressed, medical professionals have gained a better understanding of the relationship between COVID-19 and AKI. When severe symptoms are identified, doctors have become more proactive with initiating supportive care. Results from a study conducted in 2020 showed that, “AKI incidence decreased from over 40% during the first outbreak (defined as March to May 2020, with a peak in hospitalizations occurring in April) to 22% in June; by November, AKI incidence had declined to 11%.”
As AKI occurrence in COVID-19 patients decreased, so did the number of COVID-19 patients who required RRT. The same study found that, “In addition, the researchers observed a decrease in the proportion of patients who required dialysis due to COVID-19-associated AKI, from 20% in March 2020 to 6% in December.”
Looking to the Future
As medical professionals continue adapting to COVID-19 and its many complications, it is important to understand that the abnormal changes in body functions that result from AKI in patients with COVID-19 may be caused by a number of different factors. In an interview with Healio, Sergio Dellepiane, MD, PhD, of Icahn School of Medicine at Mount Sinai states, “We speculate that the changes are multifactorial and likely related to changes in patient demographics, newly available therapeutic options, improved experience of clinicians, and better resource allocation due to a decrease in case load.” Since there are no specific treatment options for AKI secondary to COVID-19, it is important to consider all available options to support kidney function. Additionally, further research is needed to improve our understanding of AKI and COVID-19, support current clinical approaches, and to develop new approaches to managing AKI in COVID-19 patients.
Opinions expressed in this article are not necessarily those of bioMérieux, Inc.
