More than a third of hospitalised covid-19 patients develop Acute kidney injury

As the global pandemic of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly emerging and expanding, its effects have become conspicious—from mild respiratory tract illness to severe acute respiratory distress syndrome (ARDS)

A large-scale study in a hospital setting of New York provides a clear evidence that kidney injury is linked to COVID-19 hospitalizations. U.S Doctors seen an appalling rise in the cases where over a third of patients treated for COVID-19 in an enormous New York hospital setting inflicts acute kidney injury, and about 15% required dialysis. The research was held by a group at Northwell Health, the best hospital claimed in New York state.

A group of investigators at Feinstein Institutes for Medical Research observed the electronic health records (EHR) of 5,449 hospitalized COVID-19 patients between March 1, 2020, and April 5, 2020 and figured out that 1,993 patients — 36.6% —suffered acute kidney injury (AKI)

“A survey revealed initial 5,449 patients conceded, 36.6% showed AKI,” said Dr. Kenar Jhaveri, associate head of nephrology at Hofstra/Northwell in Great Neck, New York. Her discoveries were published in the journal Kidney International recently.

Majority of the AKI cases happened much before COVID-19 patient’s hospitalization. About 37% either admitted at the intensive care had AKI or manifested it within 24 hours. Acute kidney injury happens when the kidneys fail miserably to filter out excretion and waste eventually leading to death if left untreated. Of those patients with kidney failure, 14.3% required dialytic support at some point after their admission.

The specialists likewise found a major link between respiratory failure and AKI. Almost 90% of patients who required mechanical ventilation manifested AKI. It occurred in just 21.7% of non-ventilated patients

About 23% of patients who is subjected to mechanical ventilation shown AKI and required dialysis treatment — in contrast to 0.2% (9 of 4,259) of non-ventilated patients.

Management of AKI in COVID-19

In the absence of specific treatment options, the care protocol for COVID-19 patients in the ICU is presently set in supportive standards. Owing to the high incidence of kidney damage in COVID-19, it is important to the doctors to ensure all available treatment options to assist kidney function.

Clinical management

Implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) supportive care guideline that includes disallowance of nephrotoxins, close monitoring of serum creatinine and urine output, consideration of haemodynamic monitoring in critically sick patients with likely kidney damage could reduce the intensity of AKI occurence in COVID-19, but requires clinical efficacy.

Another important option is to adjust fluid balance according to volume responsiveness and tolerance analysis. This technique restores normal volume status to cut down volume overload and thereby reduce the incidence of pulmonary oedema (A condition caused due to excess accumulation of fluid in lungs), right ventricular overload, congestion, and subsequent AKI.

Lately, clinical and autopsy reports of COVID-19 from China and the United States conclude high clotting and disseminated intravascular coagulation with small vessel thrombosis and pulmonary infarction. A hypercoagulable state (increased tendency to clot than usual) is frequently identified in adversely effected COVID-19 patients due to this reason. For which, anticoagulation protocols for the extracorporeal circuit (A medical procedure performed outside the body) must be tweaked in as per the requirements of patients.

Dr Michele Mokrzycki, a neurologist at the Montefiore Medical center stated to CBSN stated about dearth in dialysis machines in April. He said because of this reason, the physicians need to adapt medical procedures like peritoneal dialysis. Another issue that could happen is that the covid-19 patients who require dialysis, need to be treated individually in rooms as it could pose treat to lives of other patients. Therefore leading to inadequacy in procuring nurses to treat the patients will occur and the demand will rise to three fold.

This study proves that in the long run, greater challenges that India could see is, not only in availing ventilators for the respiratory failure but also the non-availability of nurses and dialysis machines for treating AKI.