Introduction: Acute kidney injury (AKI) is frequent in critically ill COVID-19 patients and is associated with a higher mortality risk. By increasing intrathoracic pressure, positive pressure ventilation (PPV) may reduce renal perfusion pressure by reducing venous return to the heart or by increasing renal venous congestion. This study’s aim was to evaluate the association between AKI and haemodynamic and ventilatory parameters in COVID-19 patients with ARDS. Methods: This is a single-centre retrospective observational study. Consecutive patients diagnosed with COVID-19 who met ARDS criteria and required invasive mechanical ventilation were enrolled. The relationship between respiratory and haemodynamic parameters influenced by PPV and AKI development was evaluated. AKI was defined according to KDIGO criteria. AKI recovery was evaluated a month after ICU admission and patients were classified as “recovered,” if serum creatinine (sCr) value returned to baseline, or as having “acute kidney disease” (AKD), if criteria for AKI stage 1 or greater persisted. The 6-month all-cause mortality was collected. Results: A total of 144 patients were included in the analysis. AKI occurred in 69 (48%) patients and 26 (18%) required renal replacement therapy. In a multivariate logistic regression analysis, sex, hypertension, cumulative dose of furosemide, fluid balance, and plateau pressure were independently associated with AKI. Mortality at 6 months was 50% in the AKI group and 32% in the non-AKI group (p = 0.03). Among 36 patients who developed AKI and were discharged alive from the hospital, 56% had a full renal recovery after a month, while 14%, 6%, and 14% were classified as having an AKD of stage 0, 2, and 3, respectively. Conclusions: In our cohort, AKI was independently associated with multiple variables, including high plateau pressure, suggesting a possible role of PPV on AKI development. Further studies are needed to clarify the role of mechanical ventilation on renal function.

1.
Lumlertgul
N
,
Pirondini
L
,
Cooney
E
,
Kok
W
,
Gregson
J
,
Camporota
L
, et al
.
Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study
.
Ann Intensive Care
.
2021
;
11
(
1
):
123
. .
2.
Yu
Y
,
Xu
D
,
Fu
S
,
Zhang
J
,
Yang
X
,
Xu
L
, et al
.
Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study
.
Crit Care
.
2020
;
24
(
1
):
219
. .
3.
Bayrakci
N
,
Özkan
G
,
Şakaci
M
,
Sedef
S
,
Erdem
İ
,
Tuna
N
, et al
.
The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit
.
Ther Apher Dial
.
2022
:
1744
9987
. .
4.
Robbins-Juarez
SY
,
Qian
L
,
King
KL
,
Stevens
JS
,
Husain
SA
,
Radhakrishnan
J
, et al
.
Outcomes for patients with COVID-19 and acute kidney injury: a systematic review and meta-analysis
.
Kidney Int Rep
.
2020
;
5
(
8
):
1149
60
. .
5.
Ali
H
,
Daoud
A
,
Mohamed
MM
,
Salim
SA
,
Yessayan
L
,
Baharani
J
, et al
.
Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis
.
Ren Fail
.
2020
;
42
(
1
):
393
7
. .
6.
Schaubroeck
H
,
Vandenberghe
W
,
Boer
W
,
Boonen
E
,
Dewulf
B
,
Bourgeois
C
, et al
.
Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium
.
Crit Care
.
2022
;
26
(
1
):
225
. .
7.
Su
H
,
Yang
M
,
Wan
C
,
Yi
LX
,
Tang
F
,
Zhu
HY
, et al
.
Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China
.
Kidney Int
.
2020
;
98
(
1
):
219
27
. .
8.
Fanelli
V
,
Fiorentino
M
,
Cantaluppi
V
,
Gesualdo
L
,
Stallone
G
,
Ronco
C
, et al
.
Acute kidney injury in SARS-CoV-2 infected patients
.
Crit Care
.
2020
;
24
(
1
):
155
. .
9.
Gabarre
P
,
Dumas
G
,
Dupont
T
,
Darmon
M
,
Azoulay
E
,
Zafrani
L
.
Acute kidney injury in critically ill patients with COVID-19
.
Intensive Care Med
.
2020
;
46
(
7
):
1339
48
. .
10.
Joannidis
M
,
Forni
LG
,
Klein
SJ
,
Honore
PM
,
Kashani
K
,
Ostermann
M
, et al
.
Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 workgroup
.
Intensive Care Med
.
2020
;
46
(
4
):
654
72
. .
11.
Schefold
JC
,
Filippatos
G
,
Hasenfuss
G
,
Anker
SD
,
von Haehling
S
.
Heart failure and kidney dysfunction: epidemiology, mechanisms and management
.
Nat Rev Nephrol
.
2016
;
12
(
10
):
610
23
. .
12.
Mullens
W
,
Abrahams
Z
,
Francis
GS
,
Sokos
G
,
Taylor
DO
,
Starling
RC
, et al
.
Importance of venous congestion for worsening of renal function in advanced decompensated heart failure
.
J Am Coll Cardiol
.
2009
;
53
(
7
):
589
96
. .
13.
Rangaswami
J
,
Bhalla
V
,
Blair
JEA
,
Chang
TI
,
Costa
S
,
Lentine
KL
, et al
.
Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association
.
Circulation
.
2019
;
139
(
16
):
e840
78
. .
14.
Alhazzani
W
,
Møller
MH
,
Arabi
YM
,
Loeb
M
,
Gong
MN
,
Fan
E
, et al
.
Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)
.
Intensive Care Med
.
2020
;
46
(
5
):
854
87
. .
15.
Valk
CMA
,
Tsonas
AM
,
Botta
M
,
Bos
LDJ
,
Pillay
J
,
Serpa Neto
A
, et al
.
Association of early positive end-expiratory pressure settings with ventilator-free days in patients with coronavirus disease 2019 acute respiratory distress syndrome: a secondary analysis of the Practice of VENTilation in COVID-19 study
.
Eur J Anaesthesiol
.
2021
;
38
(
12
):
1274
83
. .
16.
Ottolina
D
,
Zazzeron
L
,
Trevisi
L
,
Agarossi
A
,
Colombo
R
,
Fossali
T
, et al
.
Acute kidney injury (AKI) in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure (PEEP)
.
J Nephrol
.
2022
;
35
(
1
):
99
111
. .
17.
Husain-Syed
F
,
Slutsky
AS
,
Ronco
C
.
Lung–kidney cross-talk in the critically ill patient
.
Am J Respir Crit Care Med
.
2016
;
194
(
4
):
402
14
. .
18.
Marini
JJ
,
Ravenscraft
SA
.
Mean airway pressure: physiologic determinants and clinical importance-- Part 2: clinical implications
.
Crit Care Med
.
1992
;
20
(
11
):
1604
16
. .
19.
ARDS Definition Task Force
;
Ranieri
VM
,
Rubenfeld
GD
,
Thompson
BT
,
Ferguson
ND
,
Caldwell
E
, et al
.
Acute respiratory distress syndrome: the Berlin definition
.
JAMA
.
2012
;
307
(
23
):
2526
33
. .
20.
KDIGO clinical practice guideline for acute kidney injury
.
Kidney Int Supplements
.
2012
;
2
(
1
):
1
.
21.
Chawla
LS
,
Bellomo
R
,
Bihorac
A
,
Goldstein
SL
,
Siew
ED
,
Bagshaw
SM
, et al
.
Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 workgroup
.
Nat Rev Nephrol
.
2017
;
13
(
4
):
241
57
. .
22.
Zavada
J
,
Hoste
E
,
Cartin-Ceba
R
,
Calzavacca
P
,
Gajic
O
,
Clermont
G
, et al
.
A comparison of three methods to estimate baseline creatinine for RIFLE classification
.
Nephrol Dial Transplant
.
2010
;
25
(
12
):
3911
8
. .
23.
Wang
L
,
Li
X
,
Chen
H
,
Yan
S
,
Li
D
,
Li
Y
, et al
.
Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China
.
Am J Nephrol
.
2020
;
51
(
5
):
343
8
. .
24.
Fominskiy
EV
,
Scandroglio
AM
,
Monti
G
,
Calabrò
MG
,
Landoni
G
,
Dell’Acqua
A
, et al
.
Prevalence, characteristics, risk factors, and outcomes of invasively ventilated COVID-19 patients with acute kidney injury and renal replacement therapy
.
Blood Purif
.
2021
;
50
(
1
):
102
9
. .
25.
Hirsch
JS
,
Ng
JH
,
Ross
DW
,
Sharma
P
,
Shah
HH
,
Barnett
RL
, et al
.
Acute kidney injury in patients hospitalized with COVID-19
.
Kidney Int
.
2020
;
98
(
1
):
209
18
. .
26.
Chan
L
,
Chaudhary
K
,
Saha
A
,
Chauhan
K
,
Vaid
A
,
Zhao
S
, et al
.
AKI in hospitalized patients with COVID-19
.
J Am Soc Nephrol
.
2021
;
32
(
1
):
151
60
. .
27.
Bezerra
R
,
Teles
F
,
Mendonca
PB
,
Damte
T
,
Likaka
A
,
Ferrer-Miranda
E
, et al
.
Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study
.
Ren Fail
.
2021
;
43
(
1
):
911
8
. .
28.
Zhou
F
,
Yu
T
,
Du
R
,
Fan
G
,
Liu
Y
,
Liu
Z
, et al
.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
.
2020
;
395
(
10229
):
1054
62
. .
29.
Nadim
MK
,
Forni
LG
,
Mehta
RL
,
Connor
MJ
,
Liu
KD
,
Ostermann
M
, et al
.
COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup
.
Nat Rev Nephrol
.
2020
;
16
(
12
):
747
64
. .
30.
Shemies
RS
,
Nagy
E
,
Younis
D
,
Sheashaa
H
.
Renal replacement therapy for critically ill patients with COVID-19-associated acute kidney injury: a review of current knowledge
.
Ther Apher Dial
.
2022
;
26
(
1
):
15
23
. .
31.
Mayerhöfer
T
,
Perschinka
F
,
Klein
SJ
,
Peer
A
,
Lehner
GF
,
Bellmann
R
, et al
.
Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study
.
J Nephrol
.
2023
;
36
(
9
):
2531
40
. .
32.
Alessandri
F
,
Pistolesi
V
,
Manganelli
C
,
Ruberto
F
,
Ceccarelli
G
,
Morabito
S
, et al
.
Acute kidney injury and COVID-19: a picture from an intensive care unit
.
Blood Purif
.
2021
;
50
(
6
):
767
71
. .
33.
Drury
DR
,
Henry
JP
,
Goodman
J
.
The effects of continuous pressure breathing on kidney function 1
.
J Clin Invest
.
1947
;
26
(
5
):
945
51
. .
34.
Pannu
N
,
Mehta
RL
.
Effect of mechanical ventilation on the kidney
.
Best Pract Res Clin Anaesthesiol
.
2004
;
18
(
1
):
189
203
. .
35.
The Acute Respiratory Distress Syndrome Network
;
Brower
RG
,
Matthay
MA
,
Morris
A
,
Schoenfeld
D
,
Thompson
BT
, et al
.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome
.
New Engl J Med
.
2000
;
342
(
18
):
1301
8
. .
36.
Priebe
HJ
,
Heimann
JC
,
Hedley-Whyte
J
.
Mechanisms of renal dysfunction during positive end-expiratory pressure ventilation
.
J Appl Physiol
.
1981
;
50
(
3
):
643
9
. .
37.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network
;
Wiedemann
HP
,
Wheeler
AP
,
Bernard
GR
,
Thompson
BT
,
Hayden
D
, et al
.
Comparison of two fluid-management strategies in acute lung injury
.
N Engl J Med
.
2006
;
354
(
24
):
2564
75
. .
38.
Martensson
J
,
Bellomo
R
.
Does fluid management affect the occurrence of acute kidney injury
.
Curr Opin Anaesthesiol
.
2017
;
30
(
1
):
84
91
. .
39.
Legrand
M
,
Dupuis
C
,
Simon
C
,
Gayat
E
,
Mateo
J
,
Lukaszewicz
AC
, et al
.
Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study
.
Crit Care
.
2013
;
17
(
6
):
R278
. .
40.
Shimada
S
,
Hirose
T
,
Takahashi
C
,
Sato
E
,
Kinugasa
S
,
Ohsaki
Y
, et al
.
Pathophysiological and molecular mechanisms involved in renal congestion in a novel rat model
.
Sci Rep
.
2018
;
8
(
1
):
16808
. .
41.
Burnett
JC
,
Knox
FG
.
Renal interstitial pressure and sodium excretion during renal vein constriction
.
Am J Physiol
.
1980
;
238
(
4
):
F279
82
. .
42.
Villa
G
,
Samoni
S
,
De Rosa
S
,
Ronco
C
.
The pathophysiological hypothesis of kidney damage during intra-abdominal hypertension
.
Front Physiol
.
2016
;
7
:
55
. .
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