Abstract
Rationale & Objective: Acute kidney injury treated with kidney replacement therapy (AKI-KRT) occurs frequently in critically ill patients with coronavirus disease 2019 (COVID-19). We examined the clinical factors that determine kidney recovery in this population. Study Design: Multicenter cohort study. Setting & Participants: 4,221 adults not receiving KRT who were admitted to intensive care units at 68 US hospitals with COVID-19 from March 1 to June 22, 2020 (the “ICU cohort”). Among these, 876 developed AKI-KRT after admission to the ICU (the “AKI-KRT subcohort”). Exposure: The ICU cohort was analyzed using AKI severity as the exposure. For the AKI-KRT subcohort, exposures included demographics, comorbidities, initial mode of KRT, and markers of illness severity at the time of KRT initiation. Outcome: The outcome for the ICU cohort was estimated glomerular filtration rate (eGFR) at hospital discharge. A 3-level outcome (death, kidney nonrecovery, and kidney recovery at discharge) was analyzed for the AKI-KRT subcohort. Analytical Approach: The ICU cohort was characterized using descriptive analyses. The AKI-KRT subcohort was characterized with both descriptive analyses and multinomial logistic regression to assess factors associated with kidney nonrecovery while accounting for death. Results: Among a total of 4,221 patients in the ICU cohort, 2,361 (56%) developed AKI, including 876 (21%) who received KRT. More severe AKI was associated with higher mortality. Among survivors, more severe AKI was associated with an increased rate of kidney nonrecovery and lower kidney function at discharge. Among the 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) had kidney nonrecovery, and 193 (22%) had kidney recovery by the time of discharge. The odds of kidney nonrecovery was greater for lower baseline eGFR, with ORs of 2.09 (95% CI, 1.09-4.04), 4.27 (95% CI, 1.99-9.17), and 8.69 (95% CI, 3.07-24.55) for baseline eGFR 31-60, 16-30, ≤15 mL/min/1.73 m2, respectively, compared with eGFR > 60 mL/min/1.73 m2. Oliguria at the time of KRT initiation was also associated with nonrecovery (ORs of 2.10 [95% CI, 1.14-3.88] and 4.02 [95% CI, 1.72-9.39] for patients with 50-499 and <50 mL/d of urine, respectively, compared to ≥500 mL/d of urine). Limitations: Later recovery events may not have been captured due to lack of postdischarge follow-up. Conclusions: Lower baseline eGFR and reduced urine output at the time of KRT initiation are each strongly and independently associated with kidney nonrecovery among critically ill patients with COVID-19.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 404-416.e1 |
| Journal | American Journal of Kidney Diseases |
| Volume | 79 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2022 |
Funding
Dr Gupta has received funding from GE Healthcare and is a scientific coordinator for GlaxoSmithKline’s ASCEND study. The remaining authors declare that they have no other relevant financial interests. This work was supported by the American Society of Nephrology KidneyCure Foundation’s Ben J. Lipps Research Fellowship and NIH grant T32 DK007777 (to Dr Hsu), and NIH grants R01HL144566 and R01DK125786 (to Dr Leaf). These funders did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication. In addition to authors Hsu, Gupta,? Goyal,? Faugno, Tariq, Raichoudhury,? Sharma, Meyer, Kshirsagar, Leaf,? and Weiner, the STOP-COVID Investigators are as follows (?Site Principal Investigator). Baylor College of Medicine: Carl P. Walther? and Samaya J. Anumudu; Baylor University Medical Center: Justin Arunthamakun,? Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, and Thuy-Duyen Nguyen; Beth Israel Deaconess Medical Center: Shahzad Shaefi,? Megan L. Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D. Valencia, and Kenneth A. Bauer; Boston Medical Center: Sushrut S. Waikar? and Zoe A. Kibbelaar; Cook County Health: Ambarish M. Athavale,? Peter Hart, Shristi Upadhyay, Ishaan Vohra, and Ajiboye Oyintayo; Cooper University Health Care: Adam Green,? Jean-Sebastien Rachoin, Christa A. Schorr, and Lisa Shea; Duke University Medical Center: Daniel L. Edmonston? and Christopher L. Mosher; Hackensack Meridian Health Mountainside Medical Center: Alexandre M. Shehata,? Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor ul aain Bhatti, Bijal Mehta, and Aquino Williams; Hackensack Meridian Health Hackensack University Medical Center: Samantha K. Brenner,? Patricia Walters, Ronaldo C. Go, and Keith M. Rose; Harvard T.H. Chan School of Public Health: Miguel A. Hern?n; Harvard University: Amy M. Zhou, Ethan C. Kim, and Rebecca Lisk; Icahn School of Medicine at Mount Sinai: Lili Chan,? Kusum S. Mathews,? Steven G. Coca, Deena R. Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A. Leven, Jing G. Wang, Gohar Mosoyan, Pattharawin Pattharanitima, and Emily J. Gallagher; Indiana University School of Medicine/Indiana University Health: Allon N. Friedman,? John Guirguis, Rajat Kapoor, Christopher Meshberger, and Katherine J. Kelly; Johns Hopkins Hospital: Chirag R. Parikh,? Brian T. Garibaldi, Celia P. Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, Carmen Elena Cervantes, and Samir C. Gautam; Kings County Hospital Center: Mary C. Mallappallil,? Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, and Leon Boudourakis; Loma Linda University: H. Bryant Nguyen? and Afshin Ahoubim; Mayo Clinic, Arizona: Leslie F. Thomas? and Dheeraj Reddy Sirganagari; Mayo Clinic, Florida: Pramod K. Guru?; Mayo Clinic, Rochester: Kianoush Kashani? and Shahrzad Tehranian; Medical College of Wisconsin: Yan Zhou,? Paul A. Bergl, Jesus Rodriguez, Jatan A. Shah, and Mrigank S. Gupta; MedStar Georgetown University Hospital: Princy N. Kumar,? Deepa G. Lazarous, and Seble G. Kassaye; Montefiore Medical Center/Albert Einstein College of Medicine: Michal L. Melamed,? Tanya S. Johns. Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V. Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Jyotsana Thakkar, Neelja Kumar, Michael J. Ross, and Michael Chang; New York-Presbyterian Queens Hospital: Akshay Athreya and Mohamed Farag; New York-Presbyterian/Weill Cornell Medical Center: Edward J. Schenck,? Soo Jung Cho, Maria Plataki, Sergio L. Alvarez-Mulett, Luis G. Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, and William Whalen; New York University Langone Hospital: David Charytan? and Ashley Macina; Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine: Anand Srivastava,? Alexander S. Leidner, Carlos Martinez, Jacqueline M. Kruser, Richard G. Wunderink, and Alexander J. Hodakowski; Ochsner Medical Center: Juan Carlos Q. Velez,? Eboni G. Price-Haywood, Luis A. Matute-Trochez, Anna E. Hasty, and Muner M.B. Mohamed; Oregon Health and Science University Hospital: Rupali S. Avasare? and David Zonies?; Partners Healthcare, Brigham and Women's Hospital, Brigham and Women's Faulkner Hospital, Massachusetts General Hospital, and Newton Wellesley Hospital: Hanny Al-Samkari, Rebecca Karp Leaf, Rachel Rosovsky, Meghan E. Sise, Erik T. Newman, Samah Abu Omar, Kapil K. Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Meghan Lee, Ian A. Strohbehn, Jiahua Li, and Ariel L. Mueller; ProMedica Health System: Roberta E. Redfern,? Nicholas S. Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, and Laura Bickley; Renown Health: Chris Rowan? and Farah Madhani-Lovely?; Rush University Medical Center: Vasil Peev,? Jochen Reiser, John J. Byun, Andrew Vissing, Esha M. Kapania, Zoe Post, Nilam P. Patel, and Joy-Marie Hermes; Rutgers/New Jersey Medical School: Anne K. Sutherland,? Amee Patrawalla, Diana G. Finkel, Barbara A. Danek, Sowminya Arikapudi, Jeffrey M. Paer, Peter Cangialosi, and Mark Liotta; Rutgers/Robert Wood Johnson Medical School: Jared Radbel,? Sonika Puri, Jag Sunderram, Matthew T. Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S. Vatson, and George Karp; Stanford Healthcare, Stanford University School of Medicine: Shuchi Anand,? Joseph E. Levitt, and Pablo Garcia; Temple University Hospital: Suzanne M. Boyle? and Rui Song; Thomas Jefferson University Hospital: Jingjing Zhang,? Sang Hoon Woo, Xiaoying Deng, and Goni Katz-Greenberg; Tulane Medical Center: Moh'd A. Sharshir? and Vadym V. Rusnak; United Health Services Hospitals: Muhammad Imran Ali; University of Colorado Anschutz Medical Campus: Anip Bansal,? Amber S. Podoll, Michel Chonchol, Sunita Sharma, and Ellen L. Burnham; University Hospitals Cleveland Medical Center: Arash Rashidi? and Rana Hejal; University of Alabama-Birmingham Hospital: Eric Judd,? Laura Latta, and Ashita Tolwani; University of California-Davis Medical Center: Timothy E. Albertson? and Jason Y. Adams; University of California-Los Angeles Medical Center, Ronald Reagan-UCLA Medical Center: Steven Y. Chang? and Rebecca M. Beutler; Santa Monica-UCLA Medical Center: Carl E. Schulze; University of California-San Diego Medical Center: Etienne Macedo? and Harin Rhee; University of California-San Francisco Medical Center: Kathleen D. Liu? and Vasantha K. Jotwani; University of Chicago Medical Center: Jay L. Koyner?; University of Florida Health-Gainesville: Chintan V. Shah?; University of Florida-Health-Jacksonville: Vishal Jaikaransingh?; University of Illinois Hospital and Health Sciences System: Stephanie M. Toth-Manikowski,? Min J. Joo,? and James P. Lash; University of Kentucky Medical Center: Javier A. Neyra,? Nourhan Chaaban, Madona Elias, and Yahya Ahmad; University Medical Center of Southern Nevada: Rajany Dy,? Alfredo Iardino, and Elizabeth H. Au; University of Miami Health System: Marie Anne Sosa,? Sabrina Taldone, Gabriel Contreras, David De La Zerda, Hayley B. Gershengorn, and Alessia Fornoni; University of Michigan: Salim S. Hayek,? Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Jeff Leya, John P. Donnelly, Andrew J. Admon; University of North Carolina School of Medicine: Jennifer E. Flythe,? Matthew J. Tugman, and Emily H. Chang; University of Oklahoma Health Sciences Center: Brent R. Brown?; University of Pennsylvania Health System: Amanda K. Leonberg-Yoo,? Ryan C. Spiardi, Todd A. Miano, Meaghan S. Roche, and Charles R. Vasquez; University of Pittsburgh Medical Center: Amar D. Bansal,? Natalie C. Ernecoff, Sanjana Kapoor, Siddharth Verma, and Huiwen Chen; University of Tennessee Health Science Center and Memphis VA Medical Center/Methodist University Hospital: Csaba P. Kovesdy,? Miklos Z. Molnar,? and Ambreen Azhar; University of Texas Southwestern Medical Center and Parkland Health and Hospital System: S. Susan Hedayati,? Mridula V. Nadamuni, Shani Shastri, and Duwayne L. Willett; University of Vermont Larner College of Medicine: Samuel A.P. Short; University of Virginia Health System: Amanda D. Renaghan? and Kyle B. Enfield; University of Washington Medical Center: Pavan K. Bhatraju? and A. Bilal Malik; Vanderbilt University Medical Center: Matthew W. Semler; Washington University in St. Louis/Barnes Jewish Hospital: Anitha Vijayan,? Christina Mariyam Joy, Tingting Li, Seth Goldberg, and Patricia F. Kao; Wellforce Health System, Lowell General Hospital: Greg L. Schumaker?; Tufts Medical Center: Greg L. Schumaker; Westchester Medical Center: Marta Christov,? Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, and Savneek Chugh; and Yale School of Medicine: Perry Wilson,? Tanima Arora, and Ugochukwu Ugwuowo. Caroline M. Hsu, MD, Shruti Gupta, MD, MPH, Hocine Tighiouart, MS, Nitender Goyal, MD, Anthony J. Faugno, MD, Asma Tariq, MD, Ritesh Raichoudhury, MD, Jill H. Sharma, MD, Leah Meyer, BA, Ravi K. Kshirsagar, MD, Aju Jose, MBBS, David E. Leaf, MD, MMSc, and Daniel E. Weiner, MD, MS. Research idea and study design: CMH & SG (equal contribution), HT, NG, DEL & DEW (equal contribution); data acquisition: CMH & SG (equal contribution), HT, NG, AJF, AT, RR, JHS, LM, RKK, AJ, DEL & DEW (equal contribution); data analysis/interpretation: CMH & SG (equal contribution), HT, DEL & DEW (equal contribution); statistical analysis: CMH, HT; supervision or mentorship: SG, HT, NG, DEL & DEW (equal contribution). Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This work was supported by the American Society of Nephrology KidneyCure Foundation's Ben J. Lipps Research Fellowship and NIH grant T32 DK007777 (to Dr Hsu), and NIH grants R01HL144566 and R01DK125786 (to Dr Leaf). These funders did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication. Dr Gupta has received funding from GE Healthcare and is a scientific coordinator for GlaxoSmithKline's ASCEND study. The remaining authors declare that they have no other relevant financial interests. Received August 16, 2021. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form November 22, 2021.
Keywords
- Acute kidney injury (AKI)
- chronic kidney disease (CKD)
- coronavirus disease 2019 (COVID-19)
- critical care
- dialysis
- estimated glomerular filtration rate (eGFR)
- oligoanuria
- prognostication
- renal function
- renal recovery
- urine output
ASJC Scopus subject areas
- Nephrology
