Kidney Week

Abstract: SA-OR10

Recovery from AKI and Acute Respiratory Distress Syndrome (ARDS) with the Use of Low-Dose Steroids During COVID-19 Infection in an African American Population: A Retrospective Analysis

Session Information

• Coronavirus: Research Abstracts
  October 24, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Saggi, Subodh J., SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Subodh J. Saggi, MD, MPH



Professor of Medicine, Director Nephrology Fellowship Program, Director Extracorporeal therapies, Director Kidney Pancreas Transplant Program, SUNY Downstate Medical Center. Brooklyn, NY. I have spent many years working on AKI, Biomarkers of AKI and transition of AKI to CKD. I am also Chair of Quality Assurance Program for ESRD and Board member and Chair of Quality at IPRO ESRD Network region 2.

• Nath, Sridesh, SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Sridesh Nath,

• Culas, Roshni, Saint Barnabas Hospital, Bronx, New York, United States

Roshni Culas,

• Chittalae, Seema, SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Seema Chittalae,

• Burza, Aaliya, SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Aaliya Burza,

• Geraghty, Patrick, SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Patrick Geraghty,

• Ouyang, Jie, SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Jie Ouyang,

• Gruessner, Angelika C., SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Angelika C. Gruessner,

• Salifu, Moro O., SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Moro O. Salifu,

Background

Corona Virus Disease-19 (CoVID-19) infection associated with AKI and ARDS results in a mortality of 80%. In AA population COVID 19 presentations and outcomes are worse. NIH and Interim WHO guidelines suggest against steroids use unless in the context of clinical trials. We conducted a retrospective analysis on the impact of 2 different doses of IV steroids in AA adult population.

Methods

75 patients between March 1 and April 30, 2020 were enrolled. Primary outcomes (21-day mortality) and secondary outcomes (improvement in lung function and renal function) were analyzed. Comparisons between the steroid doses (methylprednisolone 1 mg/kg/day or 2 mg/kg/day) and no-steroid groups were performed with the Wilcoxon, Kruskal-Wallis, and Chi-Square tests. Factors affecting the recovery of AKI or ARDS were analyzed. AKI recovery was defined as 50% increase of GFR, and cessation of RRT; lung function recovery was defined as improved oxygenation by P/F ratio > 200 and extubation.

Results

38 out 75 patients received steroids. Survival in the steroids group reached 73% at 21 days compared to 36% in the non-steroids group (p<0.0006). Steroids improved the likelihood of renal function improvement by 300% (p=0.06). Lung functionwas 73% in the steroids group versus 45% in the other (p=0.01). Use of anticoagulants (16% vs 51%, p= 0.001) seemed to be interacting with steroids on outcomes. Low dose steroids had the most beneficial impact.

Conclusion

In patients with COVID-19 infection and ARDS with AKI, low dose IV methylprednisolone was associated with a significantly lower incidence of mortality and higher likelihood of renal and lung function recovery. Further investigation with a randomized control trial consisting of low dose steroids seems warranted.

Mortality in stroids and non-steroids groups