Гостре ураження нирок у пацієнтів з тяжким та критичним перебігом COVID-19

Acute kidney injury (AKI), characterized by a sudden decline in kidney function, is typically identified by an increase in serum creatinine levels and/or a decrease in urine output. It is a common complication among critically ill COVID-19 patients, with studies reporting an incidence rate of 20–40% in individuals admitted to intensive care units (ICU). The development of AKI in COVID-19 is influenced by several factors, including systemic inflammatory response, sepsis, disruptions in renin-angiotensin-aldosterone system homeostasis, rhabdomyolysis, and potential direct viral injury to the kidneys. Early identification of kidney-related complications in COVID-19 patients is essential for reducing morbidity and mortality in hospitalized patients. The objective: to investigate the incidence, risk factors, clinical characteristics, and outcomes of AKI in patients with severe and critical COVID-19. Materials and methods. A retrospective analysis of 1,311 hospitalized patients in Kyiv City Clinical Hospital No. 17 with COVID-19 (September 2020 – December 2021) identified 252 (19.2%) meeting severe or critical disease criteria. After applying exclusion criteria, 221 patients (87.7%) were included in the final analysis, comprising 113 (51.1%) women and 108 (48.9%) men. Among them, 78 (35.3%) developed AKI during hospitalization. AKI severity was classified according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria based on serum creatinine levels, with three stages indicating progressive renal dysfunction. According to the analysis of medical records, demographic and clinical data, course of the disease, and laboratory findings were analyzed. Results. Among 221 analyzed patients, 176 (79.6%) were initially admitted to other departments before being transferred to the ICU, while 45 (20.4%) were directly hospitalized from the emergency department. AKI was present in 78 (35.3%) patients and was more common in older individuals (p = 0.048). While the prevalence of cardiovascular disease and diabetes mellitus did not significantly differ between AKI and non-AKI groups, chronic kidney disease (CKD) was markedly higher in AKI patients (20.5% vs 0.7%, p < 0.0001). Laboratory findings showed higher creatinine levels (105 vs 81 μmol/L, p < 0.0001), lower estimated glomerular filtration rate (70.5 vs 84.1 mL/min/1.73 m2, p < 0.0001) and higher IL-6 (9.8 (5.2; 38.1) vs 8.4 (4.3; 36.1) pg/mL, p < 0.0001) in AKI patients, whereas hemoglobin, leukocytes, CRP, and ferritin levels did not significantly differ. Nephrotoxic medication use was significantly more common in AKI patients (65.4% vs 32.9%, p < 0.0001), while mechanical ventilation rates were similar (44.9% vs 46.2%, p = 0.854). Although ICU stays were longer for AKI patients (8.9 vs 6.3 days, p = 0.012), overall mortality did not significantly differ between AKI and non-AKI groups (39.7% vs 42.7%, p = 0.959). AKI most often developed upon ICU admission and Day 1, followed by a gradual decline, with a secondary peak after Day 7. The analysis of risk factors associated with AKI revealed that patients with CKD, with an odds ratio (OR) of 36.86 (95% confidence interval (CI) [4.78–284.1], p < 0.0001), the use of nephrotoxic medications was strongly associated with AKI (OR = 3.89; 95% CI [2.22–6.82], p < 0.0001). Older patients also had a significantly increased risk of AKI compared to younger age groups (OR = 2.56; 95% CI [1.32–4.97], p = 0.048). Conclusions. AKI was a common complication, with older age and pre-existing CKD identified as key risk factors. The use of nephrotoxic medications also showed a strong association with AKI development. While AKI patients had longer ICU stays, overall mortality did not differ significantly between those with and without AKI. These findings emphasize the importance of early risk assessment and careful management of nephrotoxic exposures in critically ill patients.