Acute Kidney Injury in Critically Ill Patients Infected With 2009 Pandemic Influenza A(H1N1): Report From a Canadian Province

Sood, Manish M.; Rigatto, Claudio; Zarychanski, Ryan; Komenda, Paul; Sood, Amy R.; Bueti, Joe; Reslerova, Martina; Roberts, Dan; Mojica, Julie; Kumar, Anand

BACKGROUND: 2009 pandemic influenza A(H1N1) has led to a global increase in severe respiratory illness. Little is known about kidney outcomes and dialytic requirements in critically ill patients infected with pandemic H1N1. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 50 patients with pandemic H1N1 admitted to any of 7 intensive care units in Manitoba, Canada, were prospectively followed. OUTCOME & MEASUREMENTS: Outcomes were kidney injury and kidney failure defined using RIFLE (risk, injury, failure, loss, end-stage disease) criteria or need for dialysis therapy. RESULTS: The pandemic H1N1 group was composed of 50 critically ill patients with pandemic H1N1 with severe respiratory syndrome (47 confirmed cases, 3 probable). Kidney injury, kidney failure, and need for dialysis occurred in 66.7%, 66%, and 11% of patients, respectively. Mortality was 16%. Kidney failure was associated with increased death (OR, 11.29; 95% CI, 1.29-98.9), whereas the need for dialysis was associated with an increase in length of stay (RR, 2.38; 95% CI, 2.13-25.75). LIMITATIONS: Small population studied from single Canadian province; thus, limited generalizability. CONCLUSIONS: In critically ill patients with pandemic H1N1, kidney injury, kidney failure, and the need for dialysis are common and associated with an increase in mortality and length of intensive care unit stay.