Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19
Background. Acute kidney injury (AKI) is a common complication of COVID-19. Several etiologies have been identified, including pigment deposition likely associated with myopathic damage. Nevertheless, the relationship between longitudinal creatine-kinase trends and renal outcomes is uncertain. Aim....
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2022/8556793 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850210400370425856 |
|---|---|
| author | Juan M. Soto-Fajardo Valeria J. Castillo-Avalos Elisa Naomi Hernandez-Paredes Airy Santillán-Cerón Jorge E. Gaytan-Arocha Olynka Vega-Vega Norma Uribe Ricardo Correa-Rotter Juan C. Ramirez-Sandoval |
| author_facet | Juan M. Soto-Fajardo Valeria J. Castillo-Avalos Elisa Naomi Hernandez-Paredes Airy Santillán-Cerón Jorge E. Gaytan-Arocha Olynka Vega-Vega Norma Uribe Ricardo Correa-Rotter Juan C. Ramirez-Sandoval |
| author_sort | Juan M. Soto-Fajardo |
| collection | DOAJ |
| description | Background. Acute kidney injury (AKI) is a common complication of COVID-19. Several etiologies have been identified, including pigment deposition likely associated with myopathic damage. Nevertheless, the relationship between longitudinal creatine-kinase trends and renal outcomes is uncertain. Aim. To correlate longitudinal changes in serum creatine-kinase levels with hospital-acquired AKI (beyond 48 h of hospital admission) in severe COVID-19 patients. Methods. This is a retrospective cohort study, and creatine-kinase levels were assessed over time in 1551 hospitalized patients with normal renal function at the time of hospital admission. Results. In subjects who developed hospital-acquired AKI (n = 126, 8.1%), the serum creatine-kinase concentration before AKI onset was not different when compared to patients without AKI (slope of log creatine-kinase/day = −0.09 [95% CI −0.17 to +0.19] vs. +0.03 [95% CI −0.1 to +0.1]). After AKI diagnosis, serum creatine-kinase levels showed a significantly ascendent slope (slope of log creatine-kinase/day after AKI diagnosis = +0.14; 95% CI + 0.05 to +0.3). The AKI evolution was the main factor associated with the creatine-kinase trend. Subjects with persistent AKI (n = 40, 32%) had rising creatine-kinase levels during hospitalization (slope of log creatine-kinase/day = +0.30 95% CI + 0.19 to +0.51). A rising creatine-kinase trend (n = 114, 8%) was associated with a 1.89-fold higher risk of in-hospital death (95% CI 1.14 to 3.16). Nevertheless, this association disappeared after adjusting AKI evolution and LDH baseline levels. Conclusion. In severe COVID-19 patients, a slight increase in creatine-kinase levels was observed after AKI occurrence but not before. Our results show that, at least for the appearance of hospital-acquired AKI, the CK rise does not meet the temporality criterion of causality regarding the occurrence of AKI. Rising creatine-kinase trends were associated with a higher risk of mortality, but this association was modified by AKI evolution and inflammation. There is a limited efficiency for AKI prognosis in the serial follow-up of CK levels in severe COVID-19 patients with normal renal function. |
| format | Article |
| id | doaj-art-944b68f912854d20926bab75b8feb593 |
| institution | OA Journals |
| issn | 2090-2158 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-944b68f912854d20926bab75b8feb5932025-08-20T02:09:47ZengWileyInternational Journal of Nephrology2090-21582022-01-01202210.1155/2022/8556793Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19Juan M. Soto-Fajardo0Valeria J. Castillo-Avalos1Elisa Naomi Hernandez-Paredes2Airy Santillán-Cerón3Jorge E. Gaytan-Arocha4Olynka Vega-Vega5Norma Uribe6Ricardo Correa-Rotter7Juan C. Ramirez-Sandoval8Department of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismDepartment of PathologyDepartment of Nephrology and Mineral MetabolismDepartment of Nephrology and Mineral MetabolismBackground. Acute kidney injury (AKI) is a common complication of COVID-19. Several etiologies have been identified, including pigment deposition likely associated with myopathic damage. Nevertheless, the relationship between longitudinal creatine-kinase trends and renal outcomes is uncertain. Aim. To correlate longitudinal changes in serum creatine-kinase levels with hospital-acquired AKI (beyond 48 h of hospital admission) in severe COVID-19 patients. Methods. This is a retrospective cohort study, and creatine-kinase levels were assessed over time in 1551 hospitalized patients with normal renal function at the time of hospital admission. Results. In subjects who developed hospital-acquired AKI (n = 126, 8.1%), the serum creatine-kinase concentration before AKI onset was not different when compared to patients without AKI (slope of log creatine-kinase/day = −0.09 [95% CI −0.17 to +0.19] vs. +0.03 [95% CI −0.1 to +0.1]). After AKI diagnosis, serum creatine-kinase levels showed a significantly ascendent slope (slope of log creatine-kinase/day after AKI diagnosis = +0.14; 95% CI + 0.05 to +0.3). The AKI evolution was the main factor associated with the creatine-kinase trend. Subjects with persistent AKI (n = 40, 32%) had rising creatine-kinase levels during hospitalization (slope of log creatine-kinase/day = +0.30 95% CI + 0.19 to +0.51). A rising creatine-kinase trend (n = 114, 8%) was associated with a 1.89-fold higher risk of in-hospital death (95% CI 1.14 to 3.16). Nevertheless, this association disappeared after adjusting AKI evolution and LDH baseline levels. Conclusion. In severe COVID-19 patients, a slight increase in creatine-kinase levels was observed after AKI occurrence but not before. Our results show that, at least for the appearance of hospital-acquired AKI, the CK rise does not meet the temporality criterion of causality regarding the occurrence of AKI. Rising creatine-kinase trends were associated with a higher risk of mortality, but this association was modified by AKI evolution and inflammation. There is a limited efficiency for AKI prognosis in the serial follow-up of CK levels in severe COVID-19 patients with normal renal function.http://dx.doi.org/10.1155/2022/8556793 |
| spellingShingle | Juan M. Soto-Fajardo Valeria J. Castillo-Avalos Elisa Naomi Hernandez-Paredes Airy Santillán-Cerón Jorge E. Gaytan-Arocha Olynka Vega-Vega Norma Uribe Ricardo Correa-Rotter Juan C. Ramirez-Sandoval Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 International Journal of Nephrology |
| title | Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 |
| title_full | Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 |
| title_fullStr | Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 |
| title_full_unstemmed | Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 |
| title_short | Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19 |
| title_sort | longitudinal changes of serum creatine kinase and acute kidney injury among patients with severe covid 19 |
| url | http://dx.doi.org/10.1155/2022/8556793 |
| work_keys_str_mv | AT juanmsotofajardo longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT valeriajcastilloavalos longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT elisanaomihernandezparedes longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT airysantillanceron longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT jorgeegaytanarocha longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT olynkavegavega longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT normauribe longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT ricardocorrearotter longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 AT juancramirezsandoval longitudinalchangesofserumcreatinekinaseandacutekidneyinjuryamongpatientswithseverecovid19 |