COVID- 19 and Augmented Renal Clearance in Critically Ill Patients

Abstract

Abstract Background: COVID-19 disease is accompanied by frequent thrombo-embolic episodes that increase mortality, as well as bacterial infections. Augmented renal clearance is a phenomenon that occurs frequently in critical patients and can provoke a therapeutic failure of renal elimination drugs. Methods: Observational epidemiological study, retrospective, in the setting of Covid-19 through the analysis of blood and urine to determine the GFR. The objectives of the study were to determine ARC incidence in the critical patient with COVID-19, compare that to a group of critical non- COVID patients and analyze the concordance of the estimation Chronic Kidney Disease Epidemiology Collaboration formula and the Glomerular Filtrate Rate calculated in 24 hour urine. Results: Eighty-two patients were included, 35 with COVID-19 and 47 without. The ARC incidence in the patients with COVID-19 was 37% and 23.4% in the non-COVID group (P=0.179). The IC mortality was similar in the COVID and nonCOVID groups (17.14% vs. 23.4%). The concordance analysis between the GFR estimated by the CKD-EPI formula and that calculated through 24 hour urine illustrated that there is not a good concordance between the GFR estimated by the CKD-EPI formula and the gold standard calculated from 24 hour urine, in such a way that the CKD-EPI value sub estimates the GFR by 39% in those with ARC. Conclusions: ARC is a very frequent occurrence in the critical patient with COVID-19 and can pass unnoticed because neither the creatinine level nor the estimation formulas detect it correctly. An excessive GFR could accompany an infra exposure to drugs designed for renal elimination such as some b-lactams and LMWH. Given that COVID-19 is a pro thrombotic disease and is also associated with infections, the 37% of COVID-19 patients could be at risk of therapeutic failure from these complications. Keywords Augmented renal clearance; B-lactam; Critically ill patient; Chronic kidney disease epidemiology collaboration formula; Glomerular filtrate rate; Incidence Abbreviations ARC: Augmented Renal Clearance; GFR: Glomerular Filtration Rate; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration Formula