High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Jacob S. Stevens*, Kristen L. King, Shelief Y. Robbins-Juarez, Pascale Khairallah, Katherine Toma, Hector Alvarado Verduzco, Emily Daniel, Denzil Douglas, Andrew A. Moses, Yonatan Peleg, Piotr Starakiewicz, Miah T. Li, Daniel W. Kim, Kathleen Yu, Long Qian, Vaqar H. Shah, Max R. O'Donnell, Matthew J. Cummings, Jason Zucker, Karthik NatarajanAdler Perotte, Demetra Tsapepas, Kiryluk Krzysztof, Geoffrey Dube, Eric Siddall, Shayan Shirazian, Thomas L. Nickolas, Maya K. Rao, Jonathan M. Barasch, Anthony M. Valeri, Jai Radhakrishnan, Ali G. Gharavi, S. Ali Husain, Sumit Mohan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

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-RRTdays; 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.

Original languageEnglish (US)
Article numbere0244131
JournalPloS one
Volume15
Issue number12 December
DOIs
StatePublished - Dec 2020
Externally publishedYes

ASJC Scopus subject areas

  • General

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