---
title: 'Acute Kidney Injury at the Conception of COVID-19'
type: 'lecture'
url: 'https://doc.social/lectures/acute-kidney-injury-at-the-conception-of-covid-19'
published: '2021-01-10'
author: 'Shay LaPorte'
topics: 'COVID19, NOLA, LSUHSC, Nephrology, Acute Kidney Injury, Dialysis'
transcript: 'yes'
---

# Acute Kidney Injury at the Conception of COVID-19

## Summary

We analyzed multiple patient factors displayed significance for the development of acute kidney injury and the requirement for dialysis in COVID-19 patients in New Orleans, LA.

## Transcript

1,183 words · 8 min · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:02] OK. Uh, how's it going, everybody? Uh, my name is Shay LaPorte and I'm a second-year medical student here at LSU New Orleans. I appreciate y'all taking some time out of y'all's day to learn a little bit more about my Research project. Um, so without further ado, here is my presentation entitled An Analysis of Patients who Developed AKI Upo admission to an academic tertiary carere Center during the first month of the acceleration phase of COVID-19 in New Orleans, Louisiana.
[0:32] So, at its conception, um, I think it goes without saying, we knew that COVID-19 was a respiratory disease. Um, however, there were papers that began to emerge out of China and the US about the renal implications of the virus and its relationship with mortality. So with that being the case, we wanted to formulate data at our own academic safety net hospital, that hospital being University Medical Center, uh, for all you New Orleans folks.
[1:00] Um, we wanted to do this project in an effort to better understand the renal consequences of the virus in our own population. Um, just to do that in an attempt to better educate ourselves, physicians, and Other healthcare workers around us.
[1:15] So the nature of our study was a retrospective cohort, um, in which we extracted data from our patients' charts, plugged that data into a redcap database, and analyzed the clinical variables of all patients admitted to UMC with a positive PCR nasopharyngeal swab for SARS-COVID-2.
[1:35] And those patients also had to subsequently develop AKI between March 9th and March 31, 2020.
[1:43] AKI in our setting was defined using criteria from the kidney Disease Improving Global outcomes, otherwise known as KATIGO. Um, that criteria gives an AKI diagnosis in any of these three circumstances, um, one being an increase in serum creatinine by 0.3 mg per deciliter within 48 hours.
[2:04] An increase in serum creatinine to 1.5 times the baseline, and to use this when the baseline is either known or presumed to have been known within the prior seven days. And the third criteria would be um a urine volume of less than 0.5 mL per kilogram per hour for six hours.
[2:25] So in our patients' cohort, there were 249 patients at our hospital that tested positive for COVID-19. Of those, 118 developed AKI. That's 47% of our initial cohort, which is a huge percentage in my opinion, and I think that should be worth noting. Um, of all the 118 patients that developed AKI 38% of them were stage one.
[2:51] While 62% had severe AKI. And in our setting, we define severe AKI as either stage 2 or stage 3.
[3:00] And as you can see in tables 1 and 2 right here, these are all the variables that were significantly associated with either the severity of AKI or the need for Dialysis.
[3:10] Now, in table one, it's clear that if you had higher stage AII, so stage 2 or 3, you were much likely, much more likely, sorry, to be admitted to the ICU, be mechanically ventilated or die.
[3:25] Um, of all the patients that developed severe AKI, 63% of our cohort was admitted to the ICU. 65% were put on mechanical ventilators, and 46% died. Again, these are all huge percentages that are worth noting, in my opinion.
[3:41] And also, in addition to that, the severe AKI patients, on average, had higher serum levels of creatinine on admit, which we expected, considering that it is the Primary marker of AKI in our setting. Um, in Other words, if a patient presented with high creatinine levels, there was a good chance that they were going to eventually develop AKI.
[4:04] Um, high phosphorus, lactate dehydrogenase, and, uh, blood urea nitrogen levels were all elevated in the severe patients, and that's makes sense as well because that's indicative of the kidney uh dysfunction in those patients.
[4:20] Now, in table two, we looked at the clinical Risk factors associated with the need for Dialysis. Um, of the 118 AKI patients in our cohort, 39 of them acquired a newfound need for Dialysis. So if patients were on Dialysis prior to the development of COVID-19 or admission to our hospital, they were excluded from the study. So everyone in our cohort that you're seeing right here are newfound cases.
[4:47] So in Other words, 33% of our patient population developed a need for Dialysis subsequent to their diagnosis of COVID-related AKI. This is an astonishing realization, in my opinion. As you can see, the associated variables are very similar for the acquisition of severe AKI as seen in table one.
[5:08] For the need for Dialysis. Um, of the 39 patients in our cohort that were dialyzed, 72% of them were admitted to our ICU. 71% were mechanically 71%, I'm sorry, were mechanically ventilated. Again, huge, huge percentages.
[5:28] So, um, with, oh, sorry. So with all that being said, um, there were still some limitations in conducting a chart review, um, namely that the data that we used that was in our charts was already there when we gained access to those charts. So that means we pretty much, we have to trust that the data that was in those charts that we analyzed and pulled from, the data was uh entered correctly.
[5:54] Um, also, this project only gives a snapshot in time of what happened at University Medical Center within that month. Therefore, we, we cannot say that this study represents Other hospitals in New Orleans or even in the state of Louisiana.
[6:09] And lastly, I think another important point to make is, if patients were readmitted to another institution, we were not able to follow up with access to their charts, to those, to their charts at those institutions. Um, so in conclusion, we analyzed the renal-specific outcomes of the patients admitted to our academic center at the initiative at the initiation of the COVID-19 Pandemic.
[6:34] Shockingly, almost half of our COVID-19 admits developed AKI, of which many shared a slew of associated clinical features.
[6:44] Um, we concluded that patients with COVID-19, who developed severe AKI were more likely to be stepped up to the ICU, require mechanical ventilation, and overall experience worse clinical outcomes. Of the 118 AKI patients, 38, which again is 1/3 of our cohort, developed a newfound need for Dialysis.
[7:05] However, with all that being said, further studies still must be conducted to determine the long-term outcomes and pathologic implications of COVID-19 on the kidney.
[7:15] So, guys, with all that being said, I'd like to end my presentation by giving a special shout out to the entire Research team who took me under their wing and gave me my first clinical Research experience, um, namely, Allison Phoebus, Alyssa Cruz, uh, Doctor Irwin Aguilar, Sean Berry, Andrew Chappell, um, Doctor
[7:37] Dearshid Yazdi and most importantly, Doctor Mira Najane. Um, I could not have done it without the help of you guys and I'm forever grateful for this opportunity. Um, thank y'all so much and thank y'all for tuning in and, uh, wanting to learn a little bit more about my project. Thanks.