THE association between invasive mechanical ventilation (IMV) and an increased risk of acute kidney injury (AKI) in critically ill patients, with a notable impact on those diagnosed with COVID-19, has been investigated in a recent multicenter study. The research analyzed data from 8,678 patients, evenly divided between COVID-19 and non-COVID-19 groups, all of whom required renal replacement therapy (RRT) during their intensive care unit (ICU) stay.
The findings indicate that, within the first week of ICU admission, COVID-19 patients had a significantly lower probability of initiating RRT compared to non-COVID-19 patients (day 1: p < 0.0001, day 2: p = 0.021). However, after seven days, this trend reversed, with COVID-19 patients exhibiting a higher hazard ratio for RRT initiation. Notably, mechanically ventilated patients across both groups faced a significantly increased risk of commencing RRT throughout their ICU stay. In the COVID-19 cohort, this risk was statistically significant, whereas, in non-COVID-19 patients, it presented as a non-significant trend. The median interval between the initiation of IMV and the requirement for RRT was longer in COVID-19 patients, averaging five days (IQR: 2–11), compared to two days (IQR: 1–5) in non-COVID-19 patients. Further analysis revealed that patients necessitating both IMV and RRT had a significantly higher risk of ICU mortality than those who did not require mechanical ventilation. The study concludes that both IMV and COVID-19 are associated with an elevated risk of RRT initiation. This association persisted across all examined time intervals. Additionally, COVID-19 patients demonstrated an increased risk for RRT initiation during their entire ICU stay. Among COVID-19 patients treated with RRT, the risk of death was significantly higher compared to their non-COVID-19 counterparts. These insights underscore the critical need for healthcare professionals to carefully consider the implications of mechanical ventilation strategies, especially in COVID-19 patients, to mitigate the risk of severe AKI and improve patient outcomes.
