Acute Kidney Injury Sub-Study

Acute Kidney Injury (AKI) and Acute Respiratory Distress Syndrome (ARDS) are closely linked condition seen in the critically ill. AKI rates of 25-60% in mechanically ventilated patients with ARF/ARDS, and AKI in this population substantially reduces survival. In the LUNG SAFE cohort AKI was seen in 39% of patients within 1 day ARDS diagnosis of ARDS. Of concern even modest elevations in creatinine was associated with worsened outcome, with hospital mortality increasing from 31% in patients with no AKI to 50% in mild- moderate AKI, and 58% in severe AKI.

AKI is a frequent and severe complication of COVID-19 and highlight the importance of assessing, defining, and reporting the course of AKI. The causal relationship between COVID-19 ARDS and AKI and its impact on outcomes remains unclear. Impaired coagulation, as in the presence of SARS-CoV2, might reduce renal perfusion with a decrease in urinary output and blood purification. In addition, support strategies like mechanical ventilation, cause or worsen kidney tubular apoptosis. PEEP, possibly through increased venous congestion may impair kidney function by reducing glomerular blood flow and urine production in animal and human studies.

The COVID-Critical study is an excellent opportunity to determine the incidence and severity of COVID-induced AKI, the impact of renal dysfunction severity, critical care management (e.g. mechanical ventilation, fluids, nephrotoxic drugs), the extent of recovery of renal function, and outcomes from COVID-19 critical illness.

This sub-study of the international COVID-19 Critical Care Consortium will enrol patients (prospectively and retrospectively) developing AKI as defined by AKIN/KDIGO network criteria during CVID-19 critical illness. It will determine influence of altered coagulation on AKI incidence and severity, the effect of MV modalities (PEEP, Proning, Neuromuscular blockade) on COVID-19 induced AKI, the outcomes of AKI in in patients with COVID-19 AHRF/ARDS.

Inclusion Criteria

  1. Same as for ECMOCARD Study patients

  2. In patients in whom mild AKI develops (serum creatinine rise >20% from baseline; or upper normal level where no evidence of CRF), eCRF automatically guides site investigator to page to join the AKI sub-study characterise these patients.

How to get involved

  1. If you are interested in participating in this sub-study please contact the Principal Investigator, John Laffey, john.laffey@nuigalway.ie

  2. You will need to submit the COVID Critical Protocol to your IRB for approval.

  3. Email your IRB approval/amendment document to ECMOCARD@health.qld.gov.au and we will arrange REDCap access to the sub-study fields.

Last Updated April 2