Dexamethasone therapy for patients hospitalized with COVID-19 appears to protect against development of severe acute kidney injury (AKI), whereas inhaled nitric oxide appears to increase the risk, investigators reported at the European Renal Association (ERA) 59th Congress held in Paris, France, and virtually.
Mickaël Bobot, MD, of Hôpitaux de Marseille and Hôpital de la Conception in Marseille, France, and colleagues analyzed data from 164 patients hospitalized with COVID-19 in 6 intensive care units. Of these, 97 (59.1%) had AKI — 39 with severe AKI (KDIGO stage 3) and 58 with mild or moderate AKI (KDIGO stage 1-2) — and 21 patients (12.8%) required renal replacement therapy.
In multivariate analysis, dexamethasone treatment and prone positioning were significantly associated with 80.6% and 76.6% reduced odds of severe AKI, respectively.
The analysis also identified factors that increase the likelihood of severe AKI. Exposure to angiotensin converting enzyme (ACE) inhibitors and inhaled nitric oxide were significantly associated with 4.2- and 5.7-fold increased odds of severe AKI, respectively. Higher APACHE II scores also were significantly associated with increased odds of severe AKI.
The investigators concluded that inhaled nitric oxide should be used with caution in patients with COVID-19-related acute respiratory distress syndrome.
Bobot M, Tonon D, Peres N, et al. Impact of dexamethasone and inhaled nitric oxide on severe acute kidney injury in critically ill patients with COVID-19. Presented at: ERA Congress, May 19-22, 2022, Paris, France. Abstract MO303.