INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.
INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically illpatients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.
Authors: Ani Nalbandian; Kartik Sehgal; Aakriti Gupta; Mahesh V Madhavan; Claire McGroder; Jacob S Stevens; Joshua R Cook; Anna S Nordvig; Daniel Shalev; Tejasav S Sehrawat; Neha Ahluwalia; Behnood Bikdeli; Donald Dietz; Caroline Der-Nigoghossian; Nadia Liyanage-Don; Gregg F Rosner; Elana J Bernstein; Sumit Mohan; Akinpelumi A Beckley; David S Seres; Toni K Choueiri; Nir Uriel; John C Ausiello; Domenico Accili; Daniel E Freedberg; Matthew Baldwin; Allan Schwartz; Daniel Brodie; Christine Kim Garcia; Mitchell S V Elkind; Jean M Connors; John P Bilezikian; Donald W Landry; Elaine Y Wan Journal: Nat Med Date: 2021-03-22 Impact factor: 53.440
Authors: Matthias Diebold; Tobias Zimmermann; Michael Dickenmann; Stefan Schaub; Stefano Bassetti; Sarah Tschudin-Sutter; Roland Bingisser; Corin Heim; Martin Siegemund; Stefan Osswald; Gabriela M Kuster; Katharina M Rentsch; Tobias Breidthardt; Raphael Twerenbold Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241
Authors: Ian A Strohbehn; Sophia Zhao; Harish Seethapathy; Meghan Lee; Nifasha Rusibamayila; Andrew S Allegretti; Xavier Vela Parada; Meghan E Sise Journal: Kidney Int Rep Date: 2021-07-15