The following is a summary of “Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study,” published in the February 2024 issue of Critical Care by Rubin et al.
Over half of ICU patients with severe COVID-19 experience Acute kidney injury (AKI), potentially due to inflammation. Dexamethasone (DXM) might offer protection, as suggested by a small study.
Researchers conducted a retrospective study across multiple centers to investigate whether DXM could prevent AKI in critically ill COVID-19 patients.
They conducted a multicenter study in three French ICUs (March 2020 to August 2021). Patients admitted to ICU for severe COVID-19. Individuals with preexistent AKI or DXM administration before admission to the ICU were excluded. DXM wasn’t used in the first wave but was administered upon ICU entry, creating two treatment groups. Multivariate Cause-specific Cox models, adjusting for ICU practice changes, evaluated DXM’s association with AKI occurrence.
The results showed 798 patients with a mean age of 62.6 years (SD 12.1), with 50% having hypertension (402/798) and 6% having previous chronic kidney disease (46/798). The median SOFA score was 4 (IQR 3–6), with 53% (420/798) requiring invasive mechanical ventilation. ICU mortality stood at 26% (208/798). AKI was present in 75% of patients (598/798): 38% had AKI KDIGO 1, 27% had AKI KDIGO 2, and 35% had AKI KDIGO 3, with 10% requiring renal replacement therapy (61/598). Patients receiving DXM exhibited a significantly decreased hazard of AKI occurrence compared to those without DXM (HR 0.67; 95% CI 0.55–0.81). Results remained consistent in analyses as excluded patients with DXM administration to AKI onset delay of less than 12 hours and incorporated the different ‘waves’ of the COVID-19 pandemic.
They concluded that in critically ill COVID-19 patients, DXM use was linked to a reduced risk of AKI, suggesting a potential strategy to prevent inflammation-related kidney injury.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01258-6
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