Abstract
IntroductionA 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.MethodsWe 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.ResultsOur 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 relevanceOur 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.
Highlights
Our analysis demonstrates the high prevalence of acute kidney injury (AKI) requiring renal replacement therapy (RRT) among critically ill patients with COVID-19 and is associated with a high mortality, the rate of renal recovery is high among survivors and should inform shared-decision making
While the recognition of acute respiratory distress syndrome (ARDS) and the obligate need for resource planning for ventilatory support was widespread, the extent of severe acute kidney injury (AKI) necessitating renal replacement therapy (RRT) and the associated prognosis for these individuals remains poorly defined given the lack of adequate phenotyping and the limited follow up in early reports
There remains uncertainty about this effect given that early cohort descriptions often did not include any kidney outcomes or RRT requirements in their ICU cohorts [7,8,9], and those that did indicated a wide range of incident AKI of any severity: 2–37% for all hospitalized patients [5,6,10,11,12,13,14], 8–75% among critically ill patients, and 5–31% with AKI requiring RRT in the ICU [12,15,16,17,18,19,20,21]
Summary
Data Availability Statement: The full dataset cannot be shared publicly because of the risk of identification of patients and their protected health information (PHI). Given the relatively specific patient sample, geographic constraints (single-site) with granular data on dates of death, the full dataset will be provided upon reasonable request following approval from The Columbia University IRB Human Research Protections Office (phone: 212.305.5883, email: sirboffice@columbia.edu). 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
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