Assessing Fluid Management and Its Association With AKI in COVID-19 Patients

ABSTRACT

Background: Managing fluid balance in COVID-19 patients can be challenging, particularly if they develop acute kidney injury (AKI). We study the relationship between fluid net input and output (FNIO) in patients with confirmed COVID-19 infection with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality. Method(s) This is a retrospective study of patients (n=403) with confirmed COVID-19. Data for FNIO was from day 1 through day 10 or until development of AKI were recorded, whichever occurred first. Available FNIO data was calculated as a mean due to information not available for all days. Covariates included demographics, comorbidities, treatment, and management variables. Result(s) Mean age was 58.1 (SD=16.5) years. There were 39.5% female and 53.1% Hispanic. Mean FNIO average was 612.2 (SD=747.4) mL. For the outcome variables, AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.4 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI1.00, 1.001, p=0.03) but was not significantly associated with AKI (p=0.82). In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.92*10-5, SE=<0.001, p=0.002) while FNIO mean was not significantly associated with LOS (p=0.75). Conclusion(s) Increased fluid balance was associated with AKI development and increased mortality. Physicians should exercise caution with administering fluid in patients with COVID-19 to prevent such adverse outcomes.