• Rev Invest Clin · Jan 2022

    Observational Study

    Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone.

    • Juan M Mejia-Vilet, Noemi Del Toro-Cisneros, Adrián E Caballero-Islas, Armando J Martínez-Rueda, John Hernández-Flores, Jefferson A Proaño-Zamudio, Víctor M Sacoto-Romo, Dheni A Fernández-Camargo, Roque A Comunidad-Bonilla, Megan A Navarro-Gerrard, José R Correa-Rotter, and Olynka Vega-Vega.
    • Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
    • Rev Invest Clin. 2022 Jan 1; 75 (2): 768976-89.

    BackgroundA high incidence of acute kidney injury (AKI) has been reported in coronavirus disease 2019 (COVID-19) patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone (DXM) as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study.ObjectiveThe objective of this study was to evaluate the association between DXM and AKI in COVID-19.MethodsIn this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of DXM treatment with the incidence, severity, and outcomes of AKI. The association between DXM treatment and AKI was evaluated by multivariable logistic regression. The association of the combination of DXM treatment and AKI on mortality was evaluated by Cox-regression analysis. Results: We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received kidney replacement therapy. Two hundred and sixty-seven (48%) patients were treated with DXM. This treatment was associated to lower incidence of AKI (Odds Radio 0.34, 95% Confidence intervals [CI] 0.22-0.52, p < 0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. DXM treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p = 0.032).ConclusionsThe incidence of AKI is high in COVID-19 patients under IMV. DXM treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI.Copyright: © 2022 Permanyer.

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