Reduction of estimated glomerular filtration rate after COVID-19-associated acute kidney injury

Bento, Gabrielle Accioly Omena; Leite, Vivian Larissa Tenório; Campos, Rodrigo Peixoto; Vaz, Flora Braga; Daher, Elizabeth De Francesco; Duarte, Daniella Bezerra

doi:10.1590/2175-8239-JBN-2022-0179en

Gabrielle Accioly Omena Bento

project design and design

data collection

analysis and interpretation

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Centro Universitário Tiradentes, Faculdade de Medicina, Maceió, AL, Brazil.

https://orcid.org/0000-0003-3170-1275

Vivian Larissa Tenório Leite

project design and design

data collection

analysis and interpretation

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Centro Universitário Tiradentes, Faculdade de Medicina, Maceió, AL, Brazil.

https://orcid.org/0000-0002-3590-8313

Rodrigo Peixoto Campos

data collection

analysis and interpretation

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil.

Centro Universitário CESMAC, Faculdade de Medicina, Maceió, AL, Brazil.

https://orcid.org/0000-0001-9956-6511

Flora Braga Vaz

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Centro Universitário CESMAC, Faculdade de Medicina, Maceió, AL, Brazil.

https://orcid.org/0000-0001-8222-6684

Elizabeth De Francesco Daher

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brazil.

https://orcid.org/0000-0003-4189-1738

Daniella Bezerra Duarte Correspondence to: Daniella Bezerra Duarte. E-mail: dabedu2@hotmail.com

project design and design

data collection

analysis and interpretation

writing and critical revision of the manuscript

Approval of the final version of the manuscript to be published

Centro Universitário Tiradentes, Faculdade de Medicina, Maceió, AL, Brazil.

Universidade Federal de Alagoas, Faculdade de Medicina, Maceió, AL, Brazil.

Centro Universitário CESMAC, Faculdade de Medicina, Maceió, AL, Brazil.

Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brazil.

https://orcid.org/0000-0002-1508-6877

Correspondence to: Daniella Bezerra Duarte. E-mail: dabedu2@hotmail.com

Conflict of Interest The authors declare that they have no conflict of interest related to the publication of this manuscript.

Authors’ Contribution

GAOB, VLTL and DBD project design and design. GAOB, VLTL, RPC and DBD data collection, analysis and interpretation. GAOB, VLTL, RPC, FBV, EFD and DBD writing and critical revision of the manuscript. GAOB, VLTL, RPC, FBV, EFD and DBD Approval of the final version of the manuscript to be published.

	Total group (n = 20)	No Hemodialysis (n = 9)	Hemodialysis (n = 11)	p
Data at hospital admission (T0)
Age, years	62 ± 11	60 ± 14	64 ± 8	0.151
Female gender, n (%)	10 (50)	3 (33.3)	7 (63.6)	0.37
Hospitalization time, days	45 (25; 50)	42 (18; 46)	47 (35; 52)	0.37
Comorbidities and treatments
Diabetes mellitus, n (%)	5 (25)	2 (22.2)	3 (27.3)	1.000
Arterial hypertension, n (%)	13 (65)	6 (66.7)	7 (63.6)	1.000
Use of ACE inhibitors or ARBs, n (%)	8 (40)	3 (33.3)	5 (45.5)	0.67
Laboratory data and Kidney function
CRP on admission, mg/dL	16.7 (3.1; 23)	4.1 (2.5; 20.4)	19.5 (4.3; 23.5)	0.175
Ferritin on admission, µg/L	1057 (532; 1521)	1140 (1029; 1636)	641 (399; 1136)	0.257
Lymphocyte count on admission, /mm³3. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31(6):1157–65. doi: http://dx.doi.org/10.1681/ASN.2020030276. PubMed PMID: 32345702. https://doi.org/10.1681/ASN.2020030276...	1219 ± 449	1111 ± 568	1307 ± 325	0.376
Basal serum Creatinine, mg/dL	0.78 (0.62; 0.9)	0.8 (0.72; 0.9)	0.7 (0.58; 0.96)	0.456
Basal eGFR, mL/min/1.73m²	95.9 ± 16.7	101.4 ± 14.2	91.3 ± 17.8	0.183
Serum creatinine on admission, mg/dL	0.99 (0.78; 1.1)	1.1 (0.98; 1.5)	0.84 (0.61; 1)	0.031
Blood urea on admission, mg/dL	33 (28; 55)	43 (31; 50)	33 (23; 62)	0.261
eGFR on admission, mL/min/1.73m²	81 ± 24	73 ± 28	88 ± 18	0.16
AKIN, n (%)				0.006
Stage 1	2 (10)	2 (22.2)	0 (0)
Stage 2	3 (15)	3 (33.3)	0 (0)
Stage 3	15 (75)	4 (44.4)	11 (100)
Parameters during hospital stay
Maximum CRP, mg/dL	32.9 (27.8; 43.9)	30.5 (25.7; 33.2)	36.9 (31.3; 47.6)	0.201
Maximum ferritin, µg/L	1650 (1504; 2982)	1901 (1650; 4029)	1597 (1417; 1650)	0.142
Minimum lymphocyte count, /mm³3. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31(6):1157–65. doi: http://dx.doi.org/10.1681/ASN.2020030276. PubMed PMID: 32345702. https://doi.org/10.1681/ASN.2020030276...	450 ± 292	420 ± 236	474 ± 340	0.691
Maximum serum creatinine, mg/dL	3.89 (3.17; 6.12)	2.94 (1.73; 3.78)	6.1 (3.94; 7.71)	<0.001
Maximum blood urea, mg/dL	200 (129; 238)	117 (85; 153)	224 (210; 257)	0.001
Serum creatinine on hospital discharge, mg/dL	1.25 (0.88; 1.83)	1.2 (0.85; 1.4)	1.5 (0.89; 2.35)	0.201
Pulmonary function during hospital stay
Pulmonary involvement on CT, n (%)				0.564
<25%	6 (33.3)	4 (44.4)	2 (22.2)
25% – 50%	3 (16.7)	2 (22.2)	1 (11.1)
50% – 75%	6 (33.3)	2 (22.2)	4 (44.4)
>75%	3 (16.7)	1 (11.1)	2 (22.2)
Invasive ventilation, n (%)	15 (75)	5 (55.6)	10 (90.9)	0.127
Use of Vasopressor, n (%)	17 (85)	6 (66.7)	11 (100)	0.074
Reassessment period (T1)
Time from discharge to follow-up, months	16 ± 3	15 ± 4	17 ± 3	0.329
Systolic blood pressure, mmHg	144 ± 17	147 ± 22	142 ± 11	0.537
Diastolic blood pressure, mmHg	93 ± 16	94 ± 22	92 ± 10	0.794
Serum creatinine, mg/dL	1.19 (0.95; 1.41)	1.06 (0.96; 1.26)	1.2 (0.79; 1.56)	0.71
eGFR, mL/min/1.73 m²	66 ± 22	71 ± 22	62 ± 22	0.386
Albuminuria, mg/g	8.3 (6; 37)	6.8 (6; 13.6)	10 (6; 41.4)	0.497
eGFR reduction, mL/min/1.73 m²	–16 (–30; –3)	–5 (–10; 7)	–19 (–39; –17)	0.004
eGFR reduction, %	–18.5 (–33; –2.5)	–4 (–14; 8)	–28 (–43; –18)	0.006
eGFR reduction rate, mL/min/year	–11.5 (–21; –2.1)	–3.5 (–10.9; –6)	–17 (–24; –9.9)	0.016
eGFR < 60 mL/min/1.73 m²	9 (45)	3 (33.3)	6 (54.5)	0.406
Microalbuminuria, n (%)	6 (31.6)	2 (22.2)	4 (40)	0.628
Hematuria, n (%)	4 (20)	1 (11.1)	3 (27.3)	0.591

	eGFR ≥ 60 mL/min/1.73m² (n = 11)	eGFR < 60 mL/min/1.73m² (n = 9)	p
Data at hospital admission (T0)
Age, years	57 ± 11	68 ± 8	0.023
Female gender, n (%)	5 (45.5)	5 (55.6)	1.000
Hospitalization time, days	31 (15; 46)	52 (45; 59)	0.003
Comorbidities and treatments
Diabetes mellitus, n (%)	2 (18.2)	3 (33.3)	0.617
Arterial hypertension, n (%)	7 (63.6)	6 (66.7)	1.000
Use of ACE inhibitors or ARBs, n (%)	4 (36.4)	4 (44.4)	1.000
Laboratory data and Kidney function
CRP on admission, mg/dL	4.1 (2.1; 20.4)	21.4 (14.6; 23.5)	0.08
Ferritin on admission, µg/L	781 (316; 1195)	1303 (917; 1579)	0.352
Lymphocyte count on admission, /mm³3. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31(6):1157–65. doi: http://dx.doi.org/10.1681/ASN.2020030276. PubMed PMID: 32345702. https://doi.org/10.1681/ASN.2020030276...	1169 ± 454	1280 ± 461	0.597
Basal serum Creatinine, mg/dL	0.75 (0.61; 0.9)	0.8 (0.62; 0.89)	1.000
Basal eGFR, mL/min/1.73m²	99.09 ± 12.91	91.89 ± 20.59	0.352
Serum creatinine on admission, mg/dL	0.98 (0.61; 1.1)	1 (0.84; 1.15)	0.23
Blood Urea on admission, mg/dL	33 (28; 49)	33 (29; 62)	0.603
eGFR on admission, mL/min/1.73m²	91 ± 20	69 ± 23	0.041
AKIN, n (%)			0,226
Stage 1	2 (18.2)	0 (0)
Stage 2	2 (18.2)	1 (11.1)
Stage 3	7 (63.6)	8 (88.9)
Parameters during hospital stay
Maximum CRP, mg/dL	30.5 (19.5; 47.6)	36.9 (32.1; 40.1)	0.23
Maximum ferritin, µg/L	1650 (1504; 1934)	1650 (1381; 4224)	0.721
Minimum lymphocyte count, /mm³3. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31(6):1157–65. doi: http://dx.doi.org/10.1681/ASN.2020030276. PubMed PMID: 32345702. https://doi.org/10.1681/ASN.2020030276...	505 ± 356	382 ± 184	0.362
Maximum serum creatinine, mg/dL	3.94 (1.73; 6.1)	3.84 (3.78; 6.14)	0.552
Maximum blood urea, mg/dL	159 (109; 239)	210 (153; 224)	0.656
Serum creatinine on hospital discharge, mg/dL	1.2 (0.7; 1.5)	1.4 (0.89; 2)	0.261
Pulmonary function during hospital stay
Pulmonary involvement on CT, n (%)			0.234
<25%	5 (55.6)	1 (11.1)
25% – 50%	1 (11.1)	2 (22.2)
50% – 75%	2 (22.2)	4 (44.4)
>75%	1 (11.1)	2 (22.2)
Invasive ventilation, n (%)	7 (63.6)	8 (88.9)	0.319
Use of Vasopressor, n (%)	9 (81.8)	8 (88.9)	1.000
Reassessment period (T1)
Time from discharge to follow-up, months	17 ± 4	16 ± 3	0.643
Systolic blood pressure, mmHg	146 ± 19	142 ± 15	0.653
Diastolic blood pressure, mmHg	92 ± 11	93 ± 21	0.878
Serum creatinine, mg/dL	1 (0.79; 1.25)	1.51 (1.2; 1.56)	0.006
eGFR, mL/min/1.73 m²	81 ± 17	48 ± 7	<0.001
Albuminuria, mg/g	6 (2.2; 11.2)	36.7 (7.6; 44.9)	0.041
eGFR reduction, mL/min/1.73m²	10 (–19; –1)	–18 (–39; –14)	0.201
eGFR reduction, %	–14 (–19; –1)	–31 (–43; –22)	0.067
eGFR reduction rate, mL/min/year	–14.4 (–24; –6.4)	–30 (–42.9; –27.7)	0.01
Microalbuminuria, n (%)	1 (9.1)	5 (62.5)	0.041
Hematuria, n (%)	1 (9.1)	3 (33.3)	0.285

[1] Correspondence to: Daniella Bezerra Duarte. E-mail: dabedu2@hotmail.com

Brasil

Brasil

Reduction of estimated glomerular filtration rate after COVID-19-associated acute kidney injury

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: