Acute kidney injury (AKI) in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure (PEEP)

• Published in: Journal of nephrology Vol. 35; no. 1; pp. 99 - 111
• Main Authors: Ottolina, Davide, Zazzeron, Luca, Trevisi, Letizia, Agarossi, Andrea, Colombo, Riccardo, Fossali, Tommaso, Passeri, Mattia, Borghi, Beatrice, Ballone, Elisabetta, Rech, Roberto, Castelli, Antonio, Catena, Emanuele, Nebuloni, Manuela, Gallieni, Maurizio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2022
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - therapy; COVID-19; Humans; Intensive Care Units; Medicine; Medicine & Public Health; Nephrology; original; original Article; Positive-Pressure Respiration - adverse effects; SARS-CoV-2; Urology; Intensive care; Covid-19; PEEP; ARDS; AKI
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-021-01100-3

Background Acute kidney injury (AKI) in Covid-19 patients admitted to the intensive care unit (ICU) is common, and its severity may be associated with unfavorable outcomes. Severe Covid-19 fulfills the diagnostic criteria for acute respiratory distress syndrome (ARDS); however, it is unclear whether there is any relationship between ventilatory management and AKI development in Covid-19 ICU patients. Purpose To describe the clinical course and outcomes of Covid-19 ICU patients, focusing on ventilatory management and factors associated with AKI development. Methods Single-center, retrospective observational study, which assessed AKI incidence in Covid-19 ICU patients divided by positive end expiratory pressure (PEEP) tertiles, with median levels of 9.6 (low), 12.0 (medium), and 14.7 cmH 2 O (high-PEEP). Results Overall mortality was 51.5%. AKI (KDIGO stage 2 or 3) occurred in 38% of 101 patients. Among the AKI patients, 19 (53%) required continuous renal replacement therapy (CRRT). In AKI patients, mortality was significantly higher versus non-AKI (81% vs. 33%, p < 0.0001). The incidence of AKI in low-, medium-, or high-PEEP patients were 16%, 38%, and 59%, respectively (p = 0.002). In a multivariate analysis, high-PEEP patients showed a higher risk of developing AKI than low-PEEP patients (OR = 4.96 [1.1–21.9] 95% CI p < 0.05). ICU mortality rate was higher in high-PEEP patients, compared to medium-PEEP or low-PEEP patients (69% vs. 44% and 42%, respectively; p = 0.057). Conclusion The use of high PEEP in Covid-19 ICU patients is associated with a fivefold higher risk of AKI, leading to higher mortality. The cause and effect relationship needs further analysis. Graphic abstract