Evaluation of the impact of the pathophysiology of acute kidney injury in patients affected by COVID-19 on clinical outcomes dialysis and death - retrospective cohort study

Abstract

The Coronavirus Disease-19, COVID-19, caused by the Sars-Cov-2 virus, was identified in humans for the first time in December 2019, in the city of Wuhan, China. It constitutes the current pandemic. The disease has been associated with either asymptomatic and mild conditions or Severe Acute Respiratory Syndrome with generalized organ dysfunction and death. The severity has been associated with several factors. One of the most important is Acute Kidney Injury (ARI). It is widely acknowledged that AKI is multifactorial, as the most relevant factors for its development are the cytokine storm, metabolic stress, medication use, rhabdomyolysis, and direct kidney tissue viral tropism. However, little is known about the impact of AKI pathophysiology on its clinical outcome. Objectives: to identify the pathophysiological mechanisms of ARI in patients affected by COVID-19 admitted to an intensive care unit and wards and to associate them with the clinical outcomes of need for dialysis and death. Methodology: retrospective cohort study that will evaluate the medical records of patients diagnosed with SARS-COV-2 infection admitted to a Tertiary Reference Public Hospital for COVD-19, from 06/01/2020 to 07/31/2021 since their admission until the outcome (hospital discharge or death). Clinical and laboratory data will be evaluated during hospitalization. The evaluation of renal function will occur through the variation of urinary output and serum creatinine measurement, and the diagnosis of AKI will follow the 2012 KDIGO criteria (Kidney Disease Improving Global Outcomes). The occurrence of AKI will be an inclusion criterion in the study. In addition to urine output and serum creatinine concentration, the results of the creatine phosphokinase and type 1 urine test will be analyzed, especially in relation to the presence of leukocyturia, proteinuria, and hematuria. Univariate and multivariate analysis will be performed to identify whether the pathophysiological mechanisms of AKI (ischemic, cytokine storm, endogenous nephrotoxic-rhabdomyolysis, or renal viral tropism) are associated with unfavorable clinical outcomes, need for dialysis, and death.(AU)