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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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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cited_by cdi_FETCH-LOGICAL-c435t-d03190c7322cb7ffd393e05cf256a4c1801276de460fe3846cbba565e112091a3
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container_end_page 176
container_issue 1
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container_title Journal of the American Society of Nephrology
container_volume 32
creator 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
description 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.
doi_str_mv 10.1681/ASN.2020060897
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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 &gt;60%. 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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. 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Rate</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Shruti</creatorcontrib><creatorcontrib>Coca, Steven G</creatorcontrib><creatorcontrib>Chan, Lili</creatorcontrib><creatorcontrib>Melamed, Michal L</creatorcontrib><creatorcontrib>Brenner, Samantha K</creatorcontrib><creatorcontrib>Hayek, Salim S</creatorcontrib><creatorcontrib>Sutherland, Anne</creatorcontrib><creatorcontrib>Puri, Sonika</creatorcontrib><creatorcontrib>Srivastava, Anand</creatorcontrib><creatorcontrib>Leonberg-Yoo, Amanda</creatorcontrib><creatorcontrib>Shehata, Alexandre M</creatorcontrib><creatorcontrib>Flythe, Jennifer E</creatorcontrib><creatorcontrib>Rashidi, Arash</creatorcontrib><creatorcontrib>Schenck, Edward J</creatorcontrib><creatorcontrib>Goyal, Nitender</creatorcontrib><creatorcontrib>Hedayati, S Susan</creatorcontrib><creatorcontrib>Dy, Rajany</creatorcontrib><creatorcontrib>Bansal, Anip</creatorcontrib><creatorcontrib>Athavale, Ambarish</creatorcontrib><creatorcontrib>Nguyen, H Bryant</creatorcontrib><creatorcontrib>Vijayan, Anitha</creatorcontrib><creatorcontrib>Charytan, David M</creatorcontrib><creatorcontrib>Schulze, Carl E</creatorcontrib><creatorcontrib>Joo, Min J</creatorcontrib><creatorcontrib>Friedman, Allon N</creatorcontrib><creatorcontrib>Zhang, Jingjing</creatorcontrib><creatorcontrib>Sosa, Marie Anne</creatorcontrib><creatorcontrib>Judd, Eric</creatorcontrib><creatorcontrib>Velez, Juan Carlos Q</creatorcontrib><creatorcontrib>Mallappallil, Mary</creatorcontrib><creatorcontrib>Redfern, Roberta E</creatorcontrib><creatorcontrib>Bansal, Amar D</creatorcontrib><creatorcontrib>Neyra, Javier A</creatorcontrib><creatorcontrib>Liu, Kathleen D</creatorcontrib><creatorcontrib>Renaghan, Amanda D</creatorcontrib><creatorcontrib>Christov, Marta</creatorcontrib><creatorcontrib>Molnar, Miklos Z</creatorcontrib><creatorcontrib>Sharma, Shreyak</creatorcontrib><creatorcontrib>Kamal, Omer</creatorcontrib><creatorcontrib>Boateng, Jeffery Owusu</creatorcontrib><creatorcontrib>Short, Samuel A P</creatorcontrib><creatorcontrib>Admon, Andrew J</creatorcontrib><creatorcontrib>Sise, Meghan E</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><creatorcontrib>Parikh, Chirag R</creatorcontrib><creatorcontrib>Leaf, David E</creatorcontrib><creatorcontrib>and the STOP-COVID Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Shruti</au><au>Coca, Steven G</au><au>Chan, Lili</au><au>Melamed, Michal L</au><au>Brenner, Samantha K</au><au>Hayek, Salim S</au><au>Sutherland, Anne</au><au>Puri, Sonika</au><au>Srivastava, Anand</au><au>Leonberg-Yoo, Amanda</au><au>Shehata, Alexandre M</au><au>Flythe, Jennifer E</au><au>Rashidi, Arash</au><au>Schenck, Edward J</au><au>Goyal, Nitender</au><au>Hedayati, S Susan</au><au>Dy, Rajany</au><au>Bansal, Anip</au><au>Athavale, Ambarish</au><au>Nguyen, H Bryant</au><au>Vijayan, Anitha</au><au>Charytan, David M</au><au>Schulze, Carl E</au><au>Joo, Min J</au><au>Friedman, Allon N</au><au>Zhang, Jingjing</au><au>Sosa, Marie Anne</au><au>Judd, Eric</au><au>Velez, Juan Carlos Q</au><au>Mallappallil, Mary</au><au>Redfern, Roberta E</au><au>Bansal, Amar D</au><au>Neyra, Javier A</au><au>Liu, Kathleen D</au><au>Renaghan, Amanda D</au><au>Christov, Marta</au><au>Molnar, Miklos Z</au><au>Sharma, Shreyak</au><au>Kamal, Omer</au><au>Boateng, Jeffery Owusu</au><au>Short, Samuel A P</au><au>Admon, Andrew J</au><au>Sise, Meghan E</au><au>Wang, Wei</au><au>Parikh, Chirag R</au><au>Leaf, David E</au><aucorp>and the STOP-COVID Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19</atitle><jtitle>Journal of the American Society of Nephrology</jtitle><addtitle>J Am Soc Nephrol</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>32</volume><issue>1</issue><spage>161</spage><epage>176</epage><pages>161-176</pages><issn>1046-6673</issn><eissn>1533-3450</eissn><abstract>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 &gt;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.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>33067383</pmid><doi>10.1681/ASN.2020060897</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-5747-2151</orcidid><orcidid>https://orcid.org/0000-0002-0928-9168</orcidid><orcidid>https://orcid.org/0000-0001-9051-7385</orcidid><orcidid>https://orcid.org/0000-0002-3847-4768</orcidid><orcidid>https://orcid.org/0000-0002-7695-3583</orcidid><orcidid>https://orcid.org/0000-0003-0180-349</orcidid><orcidid>https://orcid.org/0000-0002-9665-330</orcidid><orcidid>https://orcid.org/0000-0001-7875-090</orcidid><orcidid>https://orcid.org/0000-0003-0180-349X</orcidid><orcidid>https://orcid.org/0000-0002-9665-330X</orcidid><orcidid>https://orcid.org/0000-0001-7875-090X</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1046-6673
ispartof Journal of the American Society of Nephrology, 2021-01, Vol.32 (1), p.161-176
issn 1046-6673
1533-3450
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7894677
source Free E-Journal (出版社公開部分のみ）; PubMed Central
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
title AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
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