Dexamethasone reduces AKI in critical COVID-19 patients

Background: More than 50% of severe COVID-19 patients develop acute kidney injury (AKI) and a high percentage of them will require renal replacement therapy (RRT). The aims of this study were to identify AKI prevalence and associated factors in patients with COVID-19 and invasive mechanical ventilation (IMV). Methods: Prospective cohort analysis of all COVID-19 patients with IMV, admitted to our Institute in Mexico City (Mar 2020 -Jan 2021). AKI was defined according to KDIGO guidelines. Patients with CKD stages 4 or 5 were excluded. Demographic, clinical, laboratory, and treatment variables were registered. AKI development was analyzed by uni-and multivariate logistic regression, mortality by survival analysis. Results: Of 552 COVID-19 patients, AKI was detected in 196 (35.5%). Among AKI;80 (40.8%) were Stage 2, and 116 (59.2%) Stage 3. The incidence of each AKI stage was lower in patients treated with dexamethasone (DEXA, Fig. 1A) and decreased the requirement of RRT (30 vs 16, p=0.05). For the multivariate analysis, AKI was grouped into no AKI/Stage1 and Stage 2/3 AKI;DEXA treatment was associated with less AKI incidence (OR 0.34, 95%CI 0.23-0.51) and lower mortality in the adjusted Cox-regression analysis (Fig. 1B). Conclusions: AKI is associated with increased mortality in COVID-19 patients with IMV. The use of DEXA is associated with lower AKI severity and lower mortality.