Acute Kidney Injury, Acute Respiratory Failure, COVID
Conditions
Brief summary
This research aims to investigate the role of daily measurement of urinary cell cycle arrest markers and other serum and urinary biomarkers to predict the development of acute kidney injury in critically ill patients with COVID-19 and acute respiratory disease.
Detailed description
COVID-19 is a rapidly evolving pandemic with approximately 5% of all patients requiring admission to an intensive care unit. In critically ill patients with COVID-19, acute respiratory disease and acute kidney injury (AKI) are very common. Patients with AKI have an increased risk of mortality, especially renal replacement therapy (RRT) is required. The latest Intensive Care National Audit & Research Centre (ICNARC) report shows a 77% ICU mortality in patients with COVID-19 who require mechanical ventilation and RRT. COVID-19 associated AKI is still poorly understood. The exact underlying pathophysiology remains unknown. Furthermore, there are no specific strategies to prevent or treat AKI. Management is supportive consisting of fluid and haemodynamic optimization, discontinuation of nephrotoxic drugs and prevention of nephrotoxic exposures. Ideally, AKI needs to be recognized as early as possible for these supportive measures to be effective. Early prediction of AKI may be valuable to optimize management and improve outcomes. In critically ill patients without COVID-19, the two cell-cycle arrest markers, tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth-factor binding protein 7 (IGFBP7), have been shown to predict the development of AKI. Whether these new biomarkers also predict the development of AKI in critically ill patients with COVID-19 is unknown. The aim of this project is to explore whether urinary cell cycle arrest markers and other renal biomarkers have a role in predicting AKI in critically ill patients with COVID-19 and acute respiratory disease. The results will advance the understanding of this disease and serve to develop strategies for individualized management of this high-risk group.
Interventions
None listed
Sponsors
University Hospital Muenster
Guy's and St Thomas' NHS Foundation Trust
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Moderate or severe respiratory disease as defined by Berlin criteria 2. COVID-19 positive 3. Age ≥ 18 years
Exclusion criteria
1. pre-existing AKI 2. severe chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) \<20ml/min 3. end-stage renal failure on regular dialysis 4. kidney transplant within the last 12 months 5. pregnancy 6. breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Any stage of acute kidney injury | 7 days | As defined by Kidney Diseases: Improving Global Outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| need for RRT in first 7 days | 7 days | Renal replacement therapy requirement at the clinicians' discretion |
| Mortality | 7 and 28 days | ICU mortality |
| Duration of mechanical ventilation | 7 and 28 days | Duration |
| Duration of vasopressor support | 7 and 28 days | Duration |
Countries
United Kingdom
Contacts
Primary ContactMarlies Ostermann, MD, PhD
Backup ContactNuttha Lumlertgul, MD, PhD
Outcome results
None listed