O desfecho clínico dos pacientes hospitalizados por COVID-19 com lesão renal aguda

Abstract

Objectives: To analyze the population with acute kidney injury contaminated with COVID-19 in 2020 and to carry out a late follow-up of the clinical outcome of AKI in 2023. Methods: This was an observational, cross-sectional study with a descriptive design and a quantitative approach with a correlation between the variables. Data were collected at the Specialties Outpatient Services of a teaching hospital in the interior of São Paulo state. A survey of the number of hospitalized AKI patients who were contaminated with COVID-19 was carried out, with a total of 812 patients. Deaths, palliative care, chronic kidney disease, and deaths following readmissions were excluded. A total of 334 individuals who remained hospitalized with AKI and contaminated with COVID-19 in 2020 were recruited. The sample comprised 76 patients who were re-evaluated in 2023, with medical records being analyzed, investigated for laboratory sample collection, and medical and nursing consultations to assess renal function, risk factors, and clinical outcomes. An instrument was used to collect sociodemographic, clinical, and hospital history data. Pearson's correlation test was used, and the variable of interest was the percentage reduction in GFR, which was dichotomized into less than 20% and greater than or equal to 20%. A significance level of 5% (p=0.05) was considered. Results: The sample was divided between two groups, the first group being <20% reduction in Glomerular Filtration Rate (GFR) and the second group being > 20% reduction in GFR. The mean age, drop in GFR, and time on mechanical ventilation (MV) were significantly higher in the group with a decline in GFR of > 20%. Hospitalization time averaged 26 days in both groups. Eleven patients developed CKD and two of these required Renal Replacement Therapy (RRT). KDIGO stage 03 showed a significant correlation with length of stay, with a mean of 40.59 days, and MV time, with a mean of 13.96 days, more than double the number of days compared to stage 02. Other clinical variables from the hospital history, such as standing diastolic blood pressure, post-COVID dialysis chronic kidney disease, GFR (mL/min/1.73 m) 2023, and GFR drop, had a significant correlation of <0.01. As well as the correlation of the maximum KDIGO stage with laboratory, clinical, and sociodemographic categories: color (p=0.001), asthma, maximum creatine 2020, length of hospital stay (days), mechanical ventilation, MV time (days), did = performed hemodialysis during hospitalization and use of vasoactive drugs with p<0.01, respectively. Conclusion: The negative impact of AKI on the survival of COVID-19-contaminated patients has been observed to have an unfavorable clinical outcome. The main contributing risk factors were age, length of stay, mechanical ventilation, and maximum Kidney Disease Improving Global Outcomes (KDIGO) stage, resulting in reduced GFR and, consequently, progression to CKD. This study contributes to clinical practice with evidence of the development of AKI in hospitalized patients with COVID-19. Above all, it highlights the importance of further studies on the renal health of patients with COVID-19 and the need to follow up with these patients after hospital discharge.