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      Acute Kidney Injury in Coronavirus Disease 2019 Infected Patients: A Meta-Analytic Study

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          Abstract

          Introduction

          In clinical reports on coronavirus disease 2019 (COVID-19), the incidence of acute kidney injury (AKI) is extremely variable, although AKI is described as an independent risk factor for mortality. A meta-analysis was performed to clarify the incidence and the impact of COVID-19-related AKI on mortality.

          Methods

          All trials reporting the incidence of AKI in COVID-19 patients were searched using MEDLINE, the Cochrane Library, and EMBASE databases (last update April 26, 2020).

          Results

          Ten trials with a sample of 5,166 patients were included. AKI occurred in 947 out of 5,166 (18.3%) patients. AKI incidence was higher in severe cases: 62/305 severe patients developed AKI (20%) versus 27/1,268 nonsevere patients (2%) ( p = 0.00001). AKI occurred in 475 out of 915 (52%) deceased patients versus 183 out of 2,678 (7%) survivors ( p = 0.00001). Continuous renal replacement therapy was significantly more frequent in severe cases and in dead patients.

          Conclusion

          A significant increase in mortality rate was observed in COVID patients who developed AKI, and AKI incidence was also higher in severe cases. Any supportive strategies to protect kidney could represent valuable intervention to reduce mortality in severe COVID-19 patients.

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          Most cited references 16

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          Liver and Kidney Injuries in COVID-19 and Their Effects on Drug Therapy; a Letter to Editor

          Dear Editor, COVID-19 is a newly emerging human infectious disease of SARS-CoV-2 origin that has affected many countries around the world. COVID-19 is now rapidly spreading worldwide, and this letter is written as the World Health Organization (WHO) has declared a global emergency on January 31st amid concerns about a growing outbreak of SARS-CoV-2. Most of the published articles on COVID-19 have highlighted lungs as the main organ involved in the disease, while few articles have reported SARS-CoV-2 involvement in other organs, including liver and kidneys, which can impair the metabolism and excretion of the medications taken to treat the disease. According to Zhang et al. the incidence of hepatic abnormalities significantly increases after infection with COVID-19 and during the course of the disease, which may indicate the effect of SARS-CoV-2 on the liver or side effects of the medications used by patients (1). Also, Xu et al. have reported steatosis and liver injury in the liver biopsy of a patient with COVID-19 (2). In addition to liver injuries, some articles have also reported an increased incidence of acute renal injury following COVID-19, which could be due to the presence of SARS-CoV-2, the inflammation induced by the disease, or a synergistic effect of both on kidneys (3, 4). Additionally, Cheng et al. have reported that patients with acute renal injury have a higher mortality rate compared to other patients (3). There is currently no definitive cure for COVID-19, and the treatment regimens prescribed for patients are the main treatments that have previously been effective in SARS-CoV and MERS-CoV, and chloroquine phosphate is the only medicine whose therapeutic effect has been proven by a clinical trial. Medicines currently prescribed to treat COVID-19 include Oseltamivir, Lopinavir / Ritonavir, Ribavirin, and Chloroquine Phosphate or Hydroxy Chloroquine Sulfate. All of these medicines are metabolized in the liver. Most of the metabolites derived from Oseltamivir, Ribavirin and some of the metabolites of Lopinavir / Ritonavir, Chloroquine Phosphate and Hydroxy Chloroquine Sulfate are found in the urine due to renal excretion. Therefore, injury to the liver and kidneys can impair metabolism, excretion, dosing and expected concentrations of the medications, which can increase the risk of toxicity using the aforementioned medications. According to the reports, liver and kidneys can be damaged in patients with COVID-19, which may make reaching the therapeutic dose of the medicines difficult and increase the risk of adverse drug reactions in patients. As a result, frequent and careful monitoring of liver and kidney functions in patients with COVID-19 can lead to early diagnosis of liver and kidney disorders, and also help in achieving the optimal therapeutic concentrations and reducing the risk of adverse drug reactions.
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            Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area

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              Factors associated with acute kidney injury in acute respiratory distress syndrome

              Background Acute kidney injury (AKI) is the most frequent extra-pulmonary organ failure in acute respiratory distress syndrome (ARDS). The objective of this study was to assess the factors associated with the development and severity of AKI in patients with ARDS. Methods This is a retrospective cohort study of ARDS patients without acute or chronic kidney disease prior to the onset of ARDS over a 7-year period (2010–2017). AKI and severity of AKI were defined according to the Kidney Disease Improving Global Outcomes 2012 guidelines. Results Of the 634 ARDS patients, 357 patients met study criteria. A total of 244 (68.3%) patients developed AKI after ARDS onset: 60 (24.6%) had stage I AKI, 66 (27%) had stage II AKI, and 118 (48.4%) had stage III AKI. The median time of AKI onset for stage I AKI was 2 days (interquartile range, 1.5–5.5) while stage II and III AKI was 4 days. On multivariable analysis, factors associated with development of AKI were age [subdistribution hazard ratio (SHR) 1.01, 95% confidence interval (CI) 1.00–1.02], SOFA score (SHR 1.16, 95%CI 1.12–1.21), a history of diabetes mellitus (DM) (SHR 1.42, 95%CI 1.07–1.89), and arterial pH on day 1 of ARDS (SHR per 0.1 units decrease was 1.18, 95%CI 1.05–1.32). In severity of AKI, stage I AKI was associated with age (SHR 1.03, 95%CI 1.01–1.05) and serum bicarbonate on day 1 of ARDS (SHR 1.07, 95%CI 1.02–1.13). Stage II AKI was associated with age (SHR 1.03, 95%CI 1.01–1.05), serum bicarbonate on day 1 (SHR 1.12, 95%CI 1.06–1.18), SOFA score (SHR 1.19, 95%CI 1.10–1.30), history of heart failure (SHR 3.71, 95%CI 1.63–8.46), and peak airway pressure (SHR 1.04, 95%CI 1.00–1.07). Stage III AKI was associated with a higher BMI (SHR 1.02, 95%CI 1.00–1.03), a history of DM (SHR 1.79, 95%CI 1.18–2.72), SOFA score (SHR 1.29, 95%CI 1.22–1.36), and arterial pH on day 1 (SHR per 0.1 units decrease was 1.25, 95%CI 1.05–1.49). Conclusions Age, a higher severity of illness, a history of diabetes, and acidosis were associated with development of AKI in ARDS patients. Severity of AKI was further associated with BMI, history of heart failure, and peak airway pressure. Electronic supplementary material The online version of this article (10.1186/s13613-019-0552-5) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Blood Purif
                Blood Purif
                BPU
                Blood Purification
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                0253-5068
                1421-9735
                2 July 2020
                : 1-7
                Affiliations
                aDepartment of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Bari, Italy
                bDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
                cDepartment of Anesthesia and Resuscitation, Careggi University Hospital, University of Florence, Florence, Italy
                dDepartment of Anesthesia and Intensive Care, San Camillo Forlanini Hospital, Rome, Italy
                Author notes
                *Nicola Brienza, University Aldo Moro Emergency and Organ Transplantation, Piazza Umberto, IT–70124 Bari (Italy), brimas08@ 123456gmail.com
                Article
                bpu-0001
                10.1159/000509274
                7445379
                32615555
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                Figures: 3, Tables: 2, References: 29, Pages: 7
                Categories
                Meta-Analysis

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