Shruti Gupta1, Steven G Coca2, Lili Chan2, Michal L Melamed3, Samantha K Brenner4,5, Salim S Hayek6, Anne Sutherland7, Sonika Puri8, Anand Srivastava9, Amanda Leonberg-Yoo10, Alexandre M Shehata11, Jennifer E Flythe12,13, Arash Rashidi14, Edward J Schenck15, Nitender Goyal16, S Susan Hedayati17, Rajany Dy18, Anip Bansal19, Ambarish Athavale20, H Bryant Nguyen21, Anitha Vijayan22, David M Charytan23, Carl E Schulze24, Min J Joo25, Allon N Friedman26, Jingjing Zhang27, Marie Anne Sosa28, Eric Judd29, Juan Carlos Q Velez30,31, Mary Mallappallil32, Roberta E Redfern33, Amar D Bansal34, Javier A Neyra35, Kathleen D Liu36, Amanda D Renaghan37, Marta Christov38, Miklos Z Molnar39, Shreyak Sharma1, Omer Kamal1, Jeffery Owusu Boateng40, Samuel A P Short41, Andrew J Admon42, Meghan E Sise43, Wei Wang44,45, Chirag R Parikh46, David E Leaf47. 1. Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 2. Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. 4. Department of Internal Medicine, Hackensack Meridian School of Medicine, Seton Hall, Nutley, New Jersey. 5. Department of Internal Medicine, Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey. 6. Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan. 7. Division of Pulmonary and Critical Care Medicine, Rutgers New Jersey Medical School, Newark, New Jersey. 8. Division of Nephrology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. 9. Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 10. Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 11. Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey. 12. Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 13. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina. 14. Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 15. Divison of Pulmonary and Critical Care Medicine, Department of Medicine Weill Cornell Medicine, New York, New York. 16. Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. 17. Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. 18. Division of Pulmonary and Critical Care Medicine, University Medical Center, University of Nevada, Las Vegas, Nevada. 19. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 20. Division of Nephrology, Cook County Health, Chicago, Illinois. 21. Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University Health, Loma Linda, California. 22. Division of Nephrology, Washington University, St. Louis, Missouri. 23. Division of Nephrology, New York University Grossman School of Medicine, New York, New York. 24. Division of Nephrology, Department of Medicine, University of California, Los Angeles, California. 25. Department of Medicine, Section of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, Illinois. 26. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 27. Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 28. Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida. 29. Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama. 30. Department of Nephrology, Ochsner Health System, New Orleans, Louisiana. 31. Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia. 32. Division of Nephrology, Kings County Hospital Center, New York City Health and Hospital Corporation, Brooklyn, New York. 33. Research Department, ProMedica Research, ProMedica Toledo Hospital, Toledo, Ohio. 34. Renal and Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 35. Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky. 36. Division of Nephrology and Critical Care Medicine, University of California, San Francisco, California. 37. Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia. 38. Department of Medicine-Nephrology, Westchester Medical Center, New York Medical College, New York, New York. 39. Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. 40. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. 41. University of Vermont Larner College of Medicine, Burlington, Vermont. 42. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 43. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 44. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 45. Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts. 46. Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland. 47. Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts DELEAF@bwh.harvard.edu.
Abstract
BACKGROUND: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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