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Abstract: PO0693

COVID-Related AKI Recovery Courses with Negative Fluid Balance and Related Electrolyte Disorders

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • J. T. Melo, Ana Gabriela, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Ribeiro, Rayra Gomes, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Braga Barbosa, Géssica Sabrine, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Via Reque Cortes, Daniela del Pilar, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Sandoval Cabrera, Carla Paulina, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Rodrigues, Camila Eleuterio, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Background

Acute Kidney Injury (AKI) occurs in 3-37% of COVID patients; recovery is poorly described.

Methods

All patients who recovered from AKI in Clinics Hospital (São Paulo, Brazil) during April 2020 (COVID related-AKI (COV+), n=35) and September 2019 (COVID unrelated-AKI (COV-), n=25) were studied for 1.5 month each. Recovery was represented by spontaneous serum creatinine (sCr) drop in patients not submitted to dialysis, or by withdrawal of dialysis in those who needed the therapy. Serum creatinine, urea (sU), sodium (sNa), bicarbonate (bic), and fluid balance (FB) were analyzed during the first five days of recovery (5-Dr). Data are expressed in mean ± SD. Repeated mesaures ANOVA was used to compare different days on each parameter, and t test was used to compare groups. Categorical data were analyzed using Fisher's test.

Results

Among 88 COV- patients, 25 recovered from AKI, while 35 in 102 COV+ patients recovered during the time studied (86% COV+ were in KDIGO 3 classification). In COV+ group, COVID-AKI time was predictive of AKI duration: earlier AKI (≤ 7 days from COVID symptoms) lasted 5.6 ± 4.0 days (vs 11.9 ± 9.2 days in later AKI presentation, p< 0.05). Both COV+ and COV- patients coursed with sCr and sU drop during 5-Dr, except for diuretic users, who presented sCr drop without sU drop. COV+ patients presented negative overall FB during 5-Dr, while COV- patients presented positive FB (-516.2 ± 2730 vs 225.5 ± 5686 ml/24h). In COV+, sNa rose through 5-Dr (p< 0.05), and in COV- it did not. Among diuretic users, the same patern of FB was seen between groups (-194.9 ± 3163 in COV+ vs 163.5 ± 1080 ml/24h in COV-), and COV+ showed increased sNa through 5-Dr (p< 0.05), while COV- reduced sNa through 5-Dr (p< 0.05). Diuretic users had bicarbonate increase in COV+ (from 24.3 ± 3.6 to 27.0 ± 4.9 mmol/L, p<0.05), but not in COV-. In diuretic non-users, both groups have risen sNa through 5-Dr, but only COV+ reached statistical significance. Diuretic use at AKI-recovery was higher in COV+ patients (57% vs 28%, p< 0.05).

Conclusion

Later-onset COVID-related AKI seems to be more prolonged. Diuretics should be carefully used in AKI-recovering COV+ patients, once hypernatremia and metabolic alcalosis are more common than in other AKI etiologies.

Funding

  • Government Support - Non-U.S.