Title
Kidney function trajectory and outcomes in critically ill patients with and without COVID-19
First Author:
Mike Granda, MD, MS
Dr. Granda is an Acting Assistant Professor at UW and the KRI. He is interested in kidney imaging, kidney dysfunction in liver disease, and proximal tubular secretion. He is mentored by Bryan Kestenbaum, MD
About
Coronavirus-19 is known to affect many organs, in particular the kidneys. Loss of kidney function is common in patients with severe COVID-19 infection, although many studies of acute kidney injury (AKI) in COVID-19 did not have a comparison group to directly attribute the risk for kidney injury to coronavirus infection. Additionally, kidney function was typically only measured at a single time point and focused on glomerular filtration rate (GFR), a single excretory function of the kidney, potentially ignoring the effect of COVID-19 on other important elements of kidney function like proximal tubular secretion. Our lab is focused on developing markers of proximal tubular secretion to better understand the mechanisms and impact of various kidney diseases. In this study, we enrolled critically ill patients in Seattle area hospitals with (N=117) and without (N=64) COVID-19 and measured both the glomerular filtration rate and markers of tubular secretion up to 14-days from ICU admission.
We found that patients with COVID-19, compared to similarly ill patients without COVID-19, had a 70% greater incidence of worsening kidney function, requiring dialysis, and death. We measured markers of kidney function a median of 3 times in patients, finding that patients with COVID-19 had no improvement in kidney function (measured by GFR or our tubular secretion markers) whereas patients without COVID-19 did show some improvement by 14 days.
This study adds to our current work exposing the role of the proximal tubules in various types of kidney disease, facilitating our understanding of the pathogenesis of kidney disease. Furthermore, this study demonstrates a strong mechanistic role of tubular injury in kidney outcomes in the critically ill with and without COVID-19.
Author Information
Michael L. Granda MD MS, Frances Tian MD, Leila R. Zelnick PhD, Pavan K. Bhatraju MD MSc, Mark M. Wurfel MD PhD, Andrew Hoofnagle MD PhD, Eric Morrell MD, Bryan Kestenbaum MD MS
Publication
Critical Care Explorations
Volume 6, Issue 7 | July 2024 | e1109