Study: Acute kidney injury common in adults hospitalized with COVID-19
A new study published in the Journal of the American Society of Nephrology shows that 46% of hospitalized adults with severe COVID-19 suffer from acute kidney injury (AKI), and AKI was associated with a 50% mortality rate.
The study was based on 3,993 hospitalized patients with COVID-19 admitted to the Mount Sinai Health System in New York City from Feb 27 to May 30. Of those patients, 1,835 (46%) had AKI, and 347 (19%) of the patients with AKI required dialysis. According to the authors, in-hospital mortality was 50% among patients with AKI, versus 8% among those without AKI (adjusted odds ratio, 9.2; 95% confidence interval, 7.5 to 11.3).
Of those who survived AKI and COVID-19, only 30% recovered with complete kidney function by the time of discharge. Risk factors associated with developing AKI include older age, being a man, and having chronic kidney disease, hypertension, congestive heart failure, or diabetes.
“This study is the first study in the United States to report the persistence of kidney dysfunction (lack of recovery) in survivors of COVID-19–associated AKI,” the authors said. “Given the high incidence of AKI and lack of full recovery at and after discharge, identification of potential mechanisms of COVID-19–related AKI would allow for potential interventions to reduce this devastating complication.”
Sep 3 J Am Soc Nephrol study
No benefit found from treating COVID patients with azithromycin
A randomized controlled trial in Brazil found that adding azithromycin to standard of care treatments did not improve clinical outcomes in patients with severe COVID-19, according to a study published late last week in The Lancet.
In the open-label, randomized clinical trial, investigators at 57 Brazilian hospitals enrolled patients admitted to the hospital with COVID-19 and at least one indication of severe disease, including the use of supplemental oxygen or invasive or non-invasive mechanical ventilation. All patients in the study were randomly assigned 1:1 to treatment with the standard of care, which included the antimalaria drug hydroxychloroquine, or standard of care plus azithromycin (500 milligrams once daily for 10 days).
The primary outcome of the trial was clinical status at day 15 after randomization, assessed by a six-point ordinal scale, with higher scores indicating a worse condition and an odds ratio [OR] of greater than 1.00 favoring the standard-of-care group. The investigators also assessed safety.
A total of 447 patients were enrolled from Mar 28 to May 19. The modified intention-to-treat (mITT) population consisted of 397 patients with COVID-19 confirmed by molecular or serologic testing. In the mITT population, the primary end point was not significantly different between the azithromycin and standard-of-care groups (OR, 1.36; 95% CI, 0.94 to 1.97; P = 0.11). In the safety population, which consisted of 439 patients, there was no significant difference in rates of adverse events, including clinically relevant ventricular arrythmias, resuscitated cardiac arrest, acute kidney failure, and corrected QT-interval prolongation.
“In conclusion, in patients admitted to hospital with severe COVID-19, adding azithromycin to a standard of care (a regimen that included hydroxychloroquine) did not result in clinical improvement or mortality reduction,” the authors of the study wrote. “These findings do not support the routine use of azithromycin in combination with hydroxychloroquine for this patient population and can inform clinical practice and guidelines.”
Sep 4 Lancet study