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

Link: https://doi.org/10.1681/ASN.2020060897
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; ,

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 >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.