AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19

AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. W...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2021-01, Vol.32 (1), p.161-176
Main Authors: Gupta, Shruti, Coca, Steven G, Chan, Lili, Melamed, Michal L, Brenner, Samantha K, Hayek, Salim S, Sutherland, Anne, Puri, Sonika, Srivastava, Anand, Leonberg-Yoo, Amanda, Shehata, Alexandre M, Flythe, Jennifer E, Rashidi, Arash, Schenck, Edward J, Goyal, Nitender, Hedayati, S Susan, Dy, Rajany, Bansal, Anip, Athavale, Ambarish, Nguyen, H Bryant, Vijayan, Anitha, Charytan, David M, Schulze, Carl E, Joo, Min J, Friedman, Allon N, Zhang, Jingjing, Sosa, Marie Anne, Judd, Eric, Velez, Juan Carlos Q, Mallappallil, Mary, Redfern, Roberta E, Bansal, Amar D, Neyra, Javier A, Liu, Kathleen D, Renaghan, Amanda D, Christov, Marta, Molnar, Miklos Z, Sharma, Shreyak, Kamal, Omer, Boateng, Jeffery Owusu, Short, Samuel A P, Admon, Andrew J, Sise, Meghan E, Wang, Wei, Parikh, Chirag R, Leaf, David E
Format: Article
Language:English
Subjects:
Acute Kidney Injury - epidemiology
Acute Kidney Injury - therapy
Acute Kidney Injury - virology
Adolescent
Adult
Aged
Aged, 80 and over
Clinical Research
Cohort Studies
COVID-19 - complications
COVID-19 - mortality
COVID-19 - therapy
Critical Care
Female
Hospital Mortality
Hospitalization
Humans
Incidence
Logistic Models
Male
Middle Aged
Renal Replacement Therapy
Risk Factors
Survival Rate
United States
Young Adult
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Summary:AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2020060897