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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 161-176 |
| Number of pages | 16 |
| Journal | Journal of the American Society of Nephrology |
| Volume | 32 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2021 |
Funding
U01DK106962 (to S. Coca), R01DK115562 (to S. Coca), R01HL85757 (to S. Coca), R01DK112258 (to S. Coca), U01OH011326 (to S. Coca), R01DK126477 (to S. Coca), F32DC17342 (to S. Gupta), R01HL144566 (to D. Leaf), R01DK125786 (to D. Leaf), UL1TR001998 (to J. Neyra), R01HL085757 (to C. Parikh), and K23DK120811 (to A. Srivastava). L. Chan reports grants from NIH and Renal Research Institute, outside the submitted work. D. Charytan reports personal fees from AstraZeneca, Douglas and London, Fresenius, GSK, Merck, PLC Medical, and Zoll; grants from BioPorto; grants and personal fees from Amgen, Medtronic, Gilead, and NovoNordisk; personal fees and other from Jannssen; and other from Daichi-Sankyo, outside the submitted work. M. Christov is currently employed by New York Medical College, Regen-eron Pharmaceuticals; and reports ownership interest in Regeneron Pharmaceuticals. S. Coca is a cofounder and a member of the advisory board of RenalytixAI, and owns equity in the same. In the past 3 years, he has received consulting fees from Bayer, Boehringer-Ingelheim, CHF Solutions, pulseData, Quark Bio-pharma, Relypsa, RenalytixAI, and Takeda Pharmaceuticals as well as personal fees from inRegen. J. Flythe reports other from American Renal Associates, the American Society of Nephrology, AstraZeneca, Fresenius Medical Care, North America, the National Kidney Foundation, and NxStage Medical; and grants from Renal Research Institute and Fresenius Medical Care, outside the submitted work. A. Friedman is currently a member of the scientific advisory board for GI Dynamics and has consulted for DSMB Watermark. S. Gupta is a scientific co-ordinator for the Anaemia Studies in CKD: Erythropoiesis via a Novel PHI Dap-rodustat (ASCEND) trial (GlaxoSmithKline); and reports personal fees from GlaxoSmithKline and grants from NIH, outside the submitted work. S. Hayek is funded by National Heart, Lung, and Blood Institute (NHLBI) grant 1R01HL153384-01; the Frankel Cardiovascular Center COVID-19: Impact Research Ignitor (U-M G024231) award; and reports personal fees from Trisaq, outside the submitted work. S. Hedayati reports honoraria from the American College of Physicians for participation in Nephrology Medical Knowledge Self-Assessment Program (MKSAP) and the American Society of Nephrology Post-Graduate Education Program; is a scientific advisor for or reports membership in the American Heart Association; and reports study sections in American College of Physicians (ACP), MKSAP Nephrology Committee and the American Society of Nephrology In-Training Examination Committee. D. Leaf received research support from BioPorto. K. Liu reports grants from NIH: NHLBI and NIH: National Institute of Diabetes and Digestive and Kidney Disease (NIDDK); personal fees from the American Thoracic Society, Astra Zeneca, Baxter, Biomerieux, Durect, Potrero Med, Quark, Theravance, and UpToDate; and other from Amgen and the National Policy Forum on Critical Care and ARF, outside the submitted work. M. Melamed reports personal fees from the American Board of Internal Medicine and Icon Medical Consulting, outside the submitted work. M. Molnar reports personal fees from Abbvie, CareDx, and Natera; and grants from CareDx and Viracor, outside the submitted work. J. Neyra consults for Baxter Health-ercare, Inc. and Renibus Therapeutics, Inc. C. Parikh serves on the board of Renalytix and is a Data Safety Monitoring Board (DSMB) member for Genfit. C. Parikh reports consultancy agreements with Genfit Biopharmaceutical Company; ownership interest in Renaltix AI; research funding from NHLBI and NIDDK; and scientific advisor for or membership in Genfit Biopharmaceutical Company and Renalytix. C. Schulze is a medical director for Davita-Century City home hemodialysis program. M. Sise receives research funding from Abbvie, Gilead, MEDSerono, and Merck; honoraria from the International Society of Hemodialysis–Hemodialysis University Lecture; consultsforBioPorto; and serves on the scientific advisory board for Abbvie and Gilead. A. Srivastava received grants from NIH/NIDDK and personal fees from Horizon Pharma, Public Limited Company, AstraZeneca, and CVS Caremark. J. Velez is currently employed by Ochsner Clinic Foundation; reports consultancy agreements with Mallinckrodt Pharmaceuticals; reports honoraria from Mallinckrodt Pharmaceuticals and Ot-suka; is a scientific advisor for or reports membership in Mallinckrodt Advisory Board and Retrophin Advisory Board; and speakers bureau: Otsuka Pharmaceuticals. A. Vijayan reports consultancy agreements with Boehringer Ingelheim, NxStage, and Sanofi; reports research funding from Astellas; reports spectral honoraria from Astute and Sanofi; is a scientific advisor for or reports membership in NxStage; and is a member of the National Kidney Foundation. All remaining authors have nothing to disclose. The authors of the writing committee are supported by National Institutes of Health (NIH) grants F32HL149337 (to A. Admon), R01AG066471 (to L. Chan),
ASJC Scopus subject areas
- General Medicine
