Dataset Information

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

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-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.

SUBMITTER: Stevens JS

PROVIDER: S-EPMC7769434 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

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

Stevens Jacob S JS King Kristen L KL Robbins-Juarez Shelief Y SY Khairallah Pascale P Toma Katherine K Alvarado Verduzco Hector H Daniel Emily E Douglas Denzil D Moses Andrew A AA Peleg Yonatan Y Starakiewicz Piotr P Li Miah T MT Kim Daniel W DW Yu Kathleen K Qian Long L Shah Vaqar H VH O'Donnell Max R MR Cummings Matthew J MJ Zucker Jason J Natarajan Karthik K Perotte Adler A Tsapepas Demetra D Krzysztof Kiryluk K Dube Geoffrey G Siddall Eric E Shirazian Shayan S Nickolas Thomas L TL Rao Maya K MK Barasch Jonathan M JM Valeri Anthony M AM Radhakrishnan Jai J Gharavi Ali G AG Husain S Ali SA Mohan Sumit S

PloS one 20201228 12

<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>Our cohort ...[more]

PMID: 33370368

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Project description:Acute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of vehicle-traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients who were suffered from vehicle accidents developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of ESKD, 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. 546 vehicle-traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0-64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, vehicle-traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5-34) days vs. 6 (3-11) days; p?<?0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Vehicle-traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.473; 95% CI, 0.392-0.571; p?<?0.001), but similar rates of ESKD (HR, 1.166; 95% CI, 0.829-1.638; p?=?0.377) and short-term risk of death (HR, 1.134; 95% CI, 0.894-1.438; p?=?0.301) as non-traumatic AKI-RRT patients. In competing risk models that focused on ESKD, vehicle-traumatic AKI-RRT patients were associated with lower ESKD rates (HR, 0.552; 95% CI, 0.325-0.937; p?=?0.028) than non-traumatic AKI-RRT patients. Despite severe injuries, vehicle-traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after vehicle-traumatic AKI-RRT.

Dataset Information

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

Introduction

Methods

Results

Conclusions and relevance

Publications

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

Similar Datasets

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