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Introduction:
Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these co...
Citations
... However, few studies have directly compared the characteristics and outcomes of AKI between patients with or without COVID-19 during this critical period [6,[12][13][14][15], particularly in emerging and lower-income countries. These regions face unique healthcare challenges and resource constraints, underscoring the importance of understanding AKI in this scenario for effective management and policymaking [15,16]. Additionally, there is a dearth of comprehensive literature describing AKI outcome trajectories at hospital discharge for SARS-Cov-2-negative and positive patients amidst the pandemic's distinct healthcare challenges [14]. ...
... However, considering the severity of the presentation of COVID-19 and the scaling of ICU resources needed to treat them, public hospitals possibly fared worse due to constraints compared to private hospitals. The results of a multinational cohort study across different income levels showed that AKI in low-resource settings had the highest rate of in-hospital death (79% vs. 54% in high and 66% in upper-middle-income countries) [16]. This study has limitations. ...
Acute kidney injury (AKI) is a frequent and severe complication in COVID-19 patients, associated with poor outcomes. This study evaluates the characteristics and outcomes of AKI in COVID-19-positive versus negative patients during the pandemic in an emerging country, emphasizing differences in incidence, recovery, and healthcare resource utilization.
We conducted a retrospective cohort study including 9112 intensive care unit (ICU) patients from two major hospitals in Brazil, hospitalized between March 2020 and April 2022. Statistical analyses included logistic regression, Kaplan–Meier survival analysis, and time series analysis of AKI trends across COVID-19 waves.
2333 patients (25.6%) tested positive for COVID-19. AKI incidence (79.7% vs. 52.6%, p < 0.001) and severity (Stage 3: 48.6% vs. 26.6%, p < 0.001) were significantly higher in the COVID-19-positive group. COVID-19 patients with AKI had longer ICU stays (median 11 vs. four days, p < 0.001) and higher mechanical ventilation needs (57.9% vs. 31.1%, p < 0.001). COVID-19 independently increased the risk of AKI (OR 2.03, CI 1.77–2.32); the coexistence of COVID-19 and AKI conferred significantly higher odds for mortality (OR 8.53, CI 6.67–11.02). Kidney recovery was less frequent in COVID-19 patients, with a higher incidence of acute kidney disease in survivors (OR 1.99, CI 1.74–2.28). Sensitivity analysis of septic patients confirmed higher AKI incidence and mortality in COVID-19 patients.
COVID-19 significantly affects AKI incidence, severity, and recovery, particularly in resource-limited settings. These findings emphasize the need for targeted strategies to manage kidney complications during pandemics and stress the importance of healthcare system preparedness in emerging countries.
... Globally, over 13 million patients are affected, the majority of whom live in low-income and middle-income countries (LMICs). About 1.5 million deaths due to AKI occur annually globally [3]. ...
Background
Acute kidney injury (AKI) is a disease that affects millions of people globally making it a major public health concern. It is defined as an abrupt decrease in kidney function that occurs within ours affecting both the structure and functionality of the kidneys.
The outcome of AKI and the determinants in Nigeria are largely unknown. This study aimed to describe the determining factors of the outcome of AKI patients admitted into the ICU of three tertiary health institutions in Northeast Nigeria.
Methods
The study is a prospective multicentered observational study of the patients admitted into the ICU in three tertiary health institutions from January 2022 to December 2023. KDIGO criteria was used to define AKI. The outcome of the study was to determine survivors among the patients admitted into the ICU with AKI or developed AKI while in ICU and also the determinants of mortality. A chi-square test was done to determine the association between the dependent variable (patient outcome) and the independent variables. To determine the predictors of patient outcomes, a regression analysis was done. The sociodemographic data of the patients admitted during these periods were studied in addition to Acute Physiology and Chronic Health Evaluation (APACHE) II, Kidney Disease: Improving Global Outcomes (KDIGO), Average length of stay in the ICU, Admitting/referring ward (Obstetrics, Gynae, Medical, Surgical or Emergency unit), Ability to afford care (out of pocket payment, social welfare or through Health insurance Scheme, Co-morbidity (presence or absence of comorbidity), Interventions done while in ICU (use of vasopressors and inotropes, mechanical ventilation (MV) support and renal replacement therapy (RRT) and outcome (discharge to the wards or mortality).
Results
Of 1494 patient records screened, 464 met the inclusion criteria. The overall incidence of AKI was 57%. About 53% were females, the mean age was 42.2 years, and 81% of the patients had a normal BMI (18.5 – 24.9). About 40% of the patients had APACHE II scores ≥ 29%. More than three-quarters (79.5%) of the patients paid for their health care expenditure out-of-pocket. Most patients (72%) were from the Medical and Gynae/Ward. Mortality was highest (54.2%) among patients who were brought into the ICU from the Medical ward. Most patients admitted were KDIGO I (44.3%) followed by KDIGO II (35.1%). Among the patients, 61.2% present with one or more comorbidity. Mortality was higher (50%) among those with comorbidity compared to 13.6% among those without comorbidity. Mortality was lowest among patients who stayed in the ICU between 8–14 days compared to those who stayed > 2 weeks. Most of the patients (72%) were from the Medical and Gynae/Ward. Mortality was highest (54.2%) among patients who were brought into the ICU from the Medical ward followed by those brought in from the Obstetric and Gynecological ward (20.4%). An association was found between the intervention received in the ICU and the outcome, which was found to be statistically significant (p < 0.001). A regression analysis was done to determine the predictors of patients’ outcomes admitted in the ICU. The results showed that APACHE II score greater than 10 (p-value < 0.001), presence of comorbidities (p = 0.031) and intervention which included a combination of Vasopressors, mechanical ventilation and RRT (p < 0.01) are the predictors of patients’ outcome. The regression model is valid (X ² = 469.894, df = 24, p < 0.001) and it fits the sample as shown by the Hosmer and Lemeshow test (X ² = 7.749, p = 0.45, df = 8,). It also shows that the predictors account for 92% of patients’ outcomes (Nagelkerke R ² = 0.92).
Conclusions
Our study revealed that the presence of comorbidity, high APACHE II score, and the need for interventional supports including both mechanical ventilatory and ionotropic, were found to be strong mortality predictors in patients with AKI.
... After adjusting for the frequency of serum creatinine testing, the incidence of AKi increased to 11.6% [4]. the characteristics of the study population in relation to the severity of the disease (the virulence of the SARS-cOv-2 variant associated with the cOviD-19 wave, the burden of comorbidities [age, chronic kidney disease, heart failure, diabetes mellitus, arterial hypertension, obesity], the genetic predisposition [APOl-1 polymorphism], admission to intensive care unit or not, use of mechanical ventilation with prone position or not and the income level of the country) could account for the wide variability of the frequencies of cOv-AKi reported in the literature [2,8,[19][20][21]. in a retrospective multicenter study in the USA, chan li et al. reported an incidence of AKi of 46% with 19% of patients requiring replacement therapy and an incidence of 76% in patients admitted to intensive care unit, with 32% of patients requiring dialysis [22]. Rosa et al. revealed the impact of the prone position used in severe acute respiratory distress syndrome (ARDS) on the occurrence of AKi in cOviD-19 patients, with body mass index and low central venous pressure as determinants [23]. in fact, the prone position could be responsible for a decrease in glomerular filtration rate leading to AKi [24]. ...
... Sanchez et al. reported that AKi was more common in patients with ARDS (68% vs 53.6%, p < 0.001), in those requiring mechanical ventilation (91.9% vs 77.7%, p < 0.001), and even more so in those in the prone position (74.8% vs 61%, p < 0.001) [25]. Marina et al. in an observational and multinational study, reported that patients from lower-income countries were more likely to develop AKi, highlighting the impact of health system quality [20]. the incidence and severity of AKi (AKi requiring dialysis) decreased over time and across cOviD-19 waves, with the first wave being more severe [2,26,27]. ...
Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection is well established as a systemic disease including kidney damage. The entry point into the renal cell remains the angiotensin-converting enzyme 2 (ACE-2) receptor and the spectrum of renal lesions is broad, with a clear predominance of structural and functional tubular lesions. The most common form of glomerular injury is collapsing glomerulopathy (CG), which is strongly associated with apolipoprotein L1(APOL-1) risk variants. These acute lesions, which are secondary to the direct or indirect effects of SARS-CoV-2, can progress to chronicity and are specific to long COVID-19 in the absence of any other cause. Residual inflammation associated with SARS-CoV-2 infection, in addition to acute kidney injury (AKI) as a transitional state with or without severe histological lesions, may be responsible for greater kidney function decline in mild-to-moderate COVID-19. This review discusses the evidence for renal histological markers of chronicity in COVID-19 patients and triggers of low-grade inflammation that may explain the decline in kidney function in the post-COVID-19 period.
... 17,18,20 The incidence of AKI among ICU patients with COVID-19 was higher in LMICs at 53%, compared with 38% among patients in upper-middle-income countries and 30% among patients in high-income countries. 21 In general, children with COVID-19 had milder symptoms compared with adults. Among critically ill children admitted to the ICU, the incidence of AKI ranged between 11% and 31%, with less than 1% requiring KRT. ...
Globally,thereareanestimated13.3millioncasesofacutekidneyinjury(AKI)annually.AlthoughinfectionsareacommoncauseofAKIglobally,mostinfection-associatedAKIoccursinlow-andlower-middle-incomecountries.Therearemarkeddifferencesintheetiologyofinfection-associatedAKIacrossagegroups,populationsatrisk,andgeographiclocation.ThisarticleprovidesaglobaloverviewofdifferentinfectionsthatareassociatedcommonlywithAKI,includingsevereacuterespiratorysyndromecoronavirus2(SARS-CoV-2),humanimmunodeficiencyvirus,malaria,dengue,leptospirosis,tick-borneillnesses,andviralhemorrhagicfevers.FurtherdiscussionfocusesoninfectiousconditionsassociatedwithAKIincludingsepsis,diarrhealdiseasesandpregnancy,peripartumandneonatalAKI.Thisarticlealsodiscussesthefutureofinfection-associatedAKIintheframeworkofclimatechange.ItexploreshowincreasedinvestmentinachievingthesustainabledevelopmentgoalsmaycontributetotheInterna-tionalSocietyofNephrology’s0by25objectivetocurtailavoidableAKI-relatedfatalitiesby2025.
... By synthesizing research findings from diverse geographical regions, identifying common trends, regional variations, and knowledge gaps, this paper aims to foster a deeper understanding of the current state of the art while envisioning a future characterized by excellence, equity, and innovation. Through an interdisciplinary approach encompassing clinical practice, research, education, and policy-making, we aspire to contribute to the advancement of anesthesia and intensive care medicine on a global scale [5]. ...
This research synthesis explores the dynamic intersection of technology and patient care within the realms of Anesthesiaand Intensive Care Medicine. As technological advancements continue to reshape the landscape of healthcare, this studysynthesizes current research findings to provide a comprehensive overview of how technology is influencing and enhancingpatient care in these critical medical disciplines. The paper reviews cutting-edge technologies implemented in anesthesiaand intensive care, including the integration of artificial intelligence, digital health solutions, telemedicine, and advancedmonitoring devices. It examines how these technologies contribute to precision medicine, improve diagnostic accuracy,optimize treatment strategies, and enhance overall patient outcomes
... By synthesizing research findings from diverse geographical regions, identifying common trends, regional variations, and knowledge gaps, this paper aims to foster a deeper understanding of the current state of the art while envisioning a future characterized by excellence, equity, and innovation. Through an interdisciplinary approach encompassing clinical practice, research, education, and policy-making, we aspire to contribute to the advancement of anesthesia and intensive care medicine on a global scale [5]. ...
... Anesthesia and Intensive Care Medicine represent the cornerstone of patient care, ensuring the delicate balance between alleviating pain, enabling surgical procedures, and providing life-sustaining interventions for the critically ill. As we traverse diverse landscapes, both geographically and within the spectrum of medical practice, we encounter a myriad of experiences, challenges, and triumphs that shape the way we approach healthcare on a global scale [5]. The past decade has borne witness to an era of remarkable scientific advancements, technological innovations, and paradigm shifts in medical thinking. ...
This research paper delves into the global landscape of Anesthesia and Intensive Care Medicine, presenting acomprehensive overview of current research findings and identifying future directions in these critical medical fields. Thestudy encompasses a wide spectrum of topics, ranging from emerging technologies and innovative therapeutic approachesto patient safety, quality improvement, and ethical considerations. Drawing from a global perspective, the paper presentsa synthesis of international research efforts, identifying common trends, regional variations, and disparities in healthcarepractices. It also discusses collaborative initiatives aimed at improving global standards and fostering knowledgeexchange among healthcare communities. It discusses the ethical considerations inherent in the practice of anesthesiaand intensive care medicine, emphasizing the importance of maintaining patient welfare and safety
Aim: To identify patients at risk of AKI with severe COVID-19 and to guide management strategies according to national and global scientific data for improving kidney-related outcomes. Materials and Methods: We conducted retrospective study case-control analysing cases of hospitalisation patients with COVID-19 with or without AKI during hospital stay. Results: In the study, we found that there was a positive correlation between AKI and respiratory insufficiency (0,513 – moderate, p<0,0001), moderate in the case of AKI grade 2 (0.301, <0,001) and mild in the case of AKI grade 1 and 3 correspondingly (0.252, p<0,01; 0.277, <0,001). Lethality (in-hospital death rate) correlated with respiratory insufficiency and AKI (0.733, 0,617; p<0,0001). We found that age had a reverse correlation with AKI and RI (younger patients were more likely to have a higher prevalence of AKI and RI, p<0,001). It was noticed that AKI correlated with the minimal albumin level (-0,35, p=0,016), minimal lymphocyte count (-0.377, p<0,0001), IL-6 (0.201, p=0,035), ferritin (0.34, p <0,0001), maximal CRP (0.439, p<0,0001). There was a mild correlation between Padua Score and AKI (0,232, p<0,01) and PLRI (0,172, p=0,05). Conclusions: Early assessment of renal dysfunction could be used as a marker of severe outcomes of COVID-19, especially in the case of comorbidities such as metabolic disorders and cardiovascular events. We suggest using the Padua score, assessment of personal lethality risk index (PLRI), and rise of serum creatinine as additional tools for assessment criteria for hospitalisation.
Introdução: Pacientes com câncer apresentaram risco de desenvolver quadros respiratórios graves quando acometidos por covid-19, com necessidade de suporte intensivo e de ventilação mecânica invasiva (VMI). Objetivo: Avaliar os fatores associados ao óbito em pacientes oncológicos que tiveram covid-19 e evoluíram com insuficiência respiratória e necessidade de VMI. Método: Estudo de coorte retrospectivo de pacientes com câncer em uma unidade de terapia intensiva (UTI) oncológica, com covid-19 e em VMI de abril de 2020 a dezembro de 2021. Foram incluídos de forma sequencial todos os pacientes com câncer admitidos na UTI em VMI ou que evoluíram com VMI por agravamento da covid-19, sendo excluídos aqueles em controle da doença oncológica há mais de cinco anos. Para a análise estatística, foram utilizadas medidas de tendência central e dispersão, assim como frequências absolutas e relativas. A regressão logística múltipla foi aplicada para a avaliação dos fatores associados à mortalidade, considerando estatisticamente significantes valores de p < 0,05. Resultados: Foram incluídos no estudo 85 pacientes. O óbito foi maior entre os pacientes com tumores sólidos (OR = 3,64; IC 95%: 1,06-12,52; p = 0,04), entre os que necessitaram de suporte renal durante a internação na UTI (OR = 6,88; IC 95%: 1,82-25,98; p = 0,004), os que não puderam ser extubados (OR = 8,00; IC 95%: 2,16-29,67; p = 0,002) e os que apresentaram o valor de pressão de distensão alveolar maior do que 15cmH2O por pelo menos um dia (OR = 5,9; IC 95%: 1,76-19,80; p = 0,004). Conclusão: Características clínicas e de VMI estavam associadas à morte de pacientes oncológicos com covid-19 e em VMI.
endonasal endoscopic sinus surgery ( FESS ) is the gold standard for the treatment of patients with chronic rhinosinusitis worldwide. The task of the otorhinolaryngologist is aimed at restoring the function of the osteomyetal complex . However, the tactics of the postoperative period, especially the topical form of treatment, remain an extremely important issue. The purpose of the study: Determination of the influence of the topical form of N-acetylcysteine on the speed of recovery of patients after FESS, compared to standardized topical treatment, based on the sino-nasal outcome test. The study was carried out at the Department of Otorhinolaryngology of Bogomolets National Medical University on the basis of the Oleksandriv Clinical Hospital of Kyiv together with the CNME "Kremenchuk City Hospital of Planned Treatment", Kremenchuk. A population of 96 patients aged 18 to 60 with a diagnosis of chronic rhinosinusitis after surgical treatment. The randomization method was two groups of patients were formed. 1st group (study) - 47 patients who received irrigation of the topical form of N-acetylcysteine. 2nd group (control) - 49 patients who received topical therapy using irrigation of 0.9% NaCl solution. The volume of surgical intervention of both groups of the study: Endonasal endoscopic maxillotomy, septoplasty , bilateral vasotomy of the lower nasal turbinates. To participate in the study, all participants had to sign an informed consent. All patients were surveyed using the SNOT22 test on the 1st day before surgery treatment and on the 3rd, 10th and 28th days after surgical treatment.According to the obtained results, the effectiveness of both methods of topical treatment was revealed (p=0.001). However, the use of topical N -acetylcysteine in patients of the study group has more effective dynamics of symptoms, according to the SNOT -22 questionnaire on the 3rd (p=0.034), 10th (p=0.002) and 28th day (p=0.001) after surgical treatment. Therefore, the topical form of N-acetylcysteine has an effective effect on the speed of recovery of the mucous membrane of the nasal cavity and paranasal sinuses and improves the quality of life in patients with chronic rhinosinusitis after FESS.
