Commentary on the Article “Factors Associated with COVID-19–Related Acute Kidney Injury and Their Relationship with the Need for Renal Replacement Therapy in the Intensive Care Unit of a Peruvian Hospital”

Abstract

We carefully read the article published in the March 2025 issue of the journal by Castro Velásquez et al., entitled “Factors Associated with COVID-19–Related Acute Kidney Injury and Their Relationship with the Need for Renal Replacement Therapy in the Intensive Care Unit of a Peruvian Hospital.”

We commend the authors for their efforts to address a topic of considerable clinical relevance during the COVID-19 pandemic. Nevertheless, we believe it is important to raise several methodological considerations that may affect the interpretation of the reported findings.

We were particularly concerned by the attribution of acute kidney injury (AKI) directly to COVID-19, without distinguishing it from other potential causes, such as septic shock or exposure to nephrotoxic medications. AKI in critically ill patients is often complex and multifactorial, and not all cases can be directly attributed to the viral infection itself. The article classifies patients as having “COVID-19–related AKI”; however, the diagnostic criteria used to support this attribution are not clearly described. It is also unclear whether prerenal, intrinsic renal, and postrenal causes of AKI were systematically excluded, or whether standardized criteria were used to characterize AKI progression and determine its underlying etiology.

Furthermore, the article does not provide sufficient information regarding the presence of clinical evidence of sepsis, the need for vasopressor support, prolonged mechanical ventilation, or other factors associated with AKI secondary to hemodynamic instability or shock. These variables are particularly relevant in critically ill patients with COVID-19, in whom multiple simultaneous insults may contribute to the development and progression of AKI.