The aim of this study is to evaluate the rate and outcomes of COVID-19 associated acute kidney injury (AKI) and use of kidney replacement therapy (KRT) in critically ill COVID-19 patients in ICUs in several large hospitals in Flanders, the northern region of Belgium. We will also explore the associations between several baseline risk factors for AKI, therapeutic strategies and COVID-19 related clinical signs and the occurrence of AKI and use of KRT.
The aim of this study is to evaluate the rate and outcomes of COVID-19 associated acute kidney injury (AKI) and use of kidney replacement therapy (KRT) in critically ill COVID-19 patients in ICUs in several large hospitals in Flanders, the northern region of Belgium. We will also explore the associations between several baseline risk factors for AKI, therapeutic strategies and COVID-19 related clinical signs and the occurrence of AKI and use of KRT. This will be a cohort analysis of the rate of COVID-19 associated AKI and KRT during the period 1 February 2020 - 31 January 2021 in 6 large hospitals in Flanders Belgium and 3 Flemish University Hospitals. We will collect patients' baseline characteristics, specific treatment for COVID-19, other relevant therapies and severity of illness and ICU and hospital outcome data. AKI will be assessed during ICU stay up to 21 days of ICU stay, and will be defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. In addition, we will assess occurrence of AKI stages, duration of AKI, duration of AKI integrated with severity stage of AKI into the area under the curve of AKI, occurrence of rapid reversal of AKI, occurrence of Acute Kidney Disease (AKD) defined according to KDIGO.
Study Type
OBSERVATIONAL
Enrollment
1,286
Critical COVID-19 patients admitted to the ICU
UZ Antwerp
Antwerp, Belgium
AZ St-Jan AV
Bruges, Belgium
Ziekenhuis Oost-Limburg
Genk, Belgium
Ghent University Hospital
Ghent, Belgium
Jessa Ziekenhuis
Hasselt, Belgium
AZ Groeninge
Kortrijk, Belgium
UZ Leuven
Leuven, Belgium
AZ Delta
Roeselare, Belgium
AZ Turnhout
Turnhout, Belgium
Acute Kidney Injury (AKI)
AKI occurrence and severity stages defined according to KDIGO
Time frame: up to day 21 of ICU admission
Kidney outcome
use of KRT and eGFR in patients without AKI (no AKI), AKI, and AKI stages
Time frame: day 30 after ICU admission
Mortality
Mortality of AKI and no AKI patients will be compared
Time frame: day 30 after ICU admission
Survival
Survival of no AKI, AKI and AKI stages, AKD, and rapid reversal up to day 30 or hospital discharge whichever comes last
Time frame: AKI and AKD will be classified up to day 21 of ICU stay, and survival will be assessed up to day 30 or hospital discharge whichever is last
Acute Kidney Injury (AKI) creatinine criteria
AKI occurrence and severity stages defined according to KDIGO creatinine criteria
Time frame: up to day 21 of ICU admission
Acute Kidney Injury (AKI) urine output criteria
AKI occurrence and severity stages defined according to KDIGO urine output criteria
Time frame: up to day 21 of ICU admission
Acute Kidney Injury (AKI), rapid reversal
Occurrence of AKI for 48-h or less
Time frame: up to day 21 of ICU admission
Acute Kidney Disease (AKD)
Occurrence and severity staging of AKD according to KDIGO criteria
Time frame: up to day 21 of ICU admission
AKI-Area Under the Curve (AUC)
Assessment of AKI-AUC which is defined as the sum of the daily maximum severity stage of AKI
Time frame: up to day 21 of ICU admission
Mortality AKD
Mortality of patients with AKD and severity stages of AKD will be compared to no AKI and patients with AKI and different AKI stages
Time frame: day 30 after ICU admission
Mortality AKI rapid reversal
Mortality of patients with AKI rapid reversal ill be compared to no AKI and patients with AKI and different AKI stages
Time frame: day 30 after ICU admission
Mortality AKI stage 2-3
Mortality of patients with AKI stage 2 or greater and patients with no AKI or AKI stage 1 will be compared
Time frame: day 30 after ICU admission
Mortality AKI treated with KRT
Mortality of patients with AKI treated with KRT and patients with no AKI or AKI stage 1, 2 or 3 will be compared
Time frame: day 30 after ICU admission
Mortality AKI creatinine criteria versus urine output criteria versus full KDIGO
Mortality of patients with AKI and patients with no AKI will be compared
Time frame: day 30 after ICU admission
Mortality AKI-AUC
Mortality of quartiles of AKI-AUC will be assessed
Time frame: day 30 after ICU admission
Kidney outcome AKI KDIGO creatinine or urine output
use of KRT and eGFR in no AKI, AKI on creatinine or urine output criteria and AKI stages, Rapid Reversal of AKI, and AKD and stages
Time frame: day 30 after ICU admission
Duration of AKI and AKD
Duration of AKI, AKI on creatinine or urine output criteria and AKI stages, Rapid Reversal of AKI, and AKD and stages
Time frame: up to day 21 of ICU admission
Survival AKI-AUC
Survival up to day 30 or hospital discharge (whichever is last) for quartiles of AKI-AUC will be assessed
Time frame: AKI-AUC will be assessed up to day 21 of ICU stay, and survival will be assessed up to day 30 or hospital discharge whichever is last
Recovery of AKI and AKD
Recovery of AKI, AKI stages, AKD and AKD stages, KRT will be assessed
Time frame: day 30 after ICU admission
Timing of AKI, AKI severity grades and use of KRT
timing of occurrence of AKI in relation to onset of symptoms, hospital admission, ICU admission
Time frame: ICU admission up to day 21
KRT modality
initial modality of KRT and anticoagulation used
Time frame: ICU admission up to day 21
use of KRT
number of KRT treatment days, and KRT free days
Time frame: ICU admission up to day 21
Subgroup analysis: Mechanical Ventilation
outcomes will be assessed in patients with and without mechanical ventilation at time of start of AKI
Time frame: ICU admission up to day 21
Subgroup analysis: Chronic Kidney Disease (CKD) (estimated glomerular filtration rate (eGFR)<60 mL/min)
outcomes will be assessed in patients with and without CKD as baseline kidney function
Time frame: ICU admission up to day 21
Subgroup analysis: elderly (>= 65 y)
outcomes will be assessed in patients older and younger than 65y
Time frame: ICU admission up to day 21
Subgroup analysis: obese (BMI>30 kg/m2)
outcomes will be assessed in obese patients and non-obese
Time frame: ICU admission up to day 21
Subgroup analysis: prone ventilation
outcomes will be assessed in patients treated with mechanical ventilation and in prone position
Time frame: ICU admission up to day 21
Subgroup analysis: extracorporeal membrane oxygenation (ECMO)
outcomes will be assessed in patients treated with ECMO
Time frame: ICU admission up to day 21
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