Dataset Information

Acute kidney injury requiring renal replacement therapy in people with COVID-19 disease in Ontario, Canada: a prospective analysis of risk factors and outcomes

ABSTRACT: Abstract

Background

Severely ill people with COVID-19 are at risk of acute kidney injury treated with renal replacement therapy (AKI-RRT). Understanding of risk factors and outcomes for AKI-RRT is incomplete.

Methods

We prospectively collected data on the incidence, demographics, area of residence, time course, outcomes, and associated risk factors for all COVID-19 AKI-RRT cases during the first 2 waves of the pandemic in Ontario, Canada

Results

There were 271 people with AKI-RRT, representing 0.1% of all diagnosed SARS-CoV-2 cases. These included 10% of SARS-CoV-2 admissions to intensive care units (ICU). Median age was 65 years, with 11% under 50, 76% were male, 47% non-white, and 48% had diabetes. Overall, 59% resided in the quintile of Ontario neighborhoods with the greatest ethnocultural composition and 51% in the 2 lowest income quintile neighborhoods. Mortality was 58% at 30 days after RRT initiation, and 64% at 90 days. By 90 days, 20% of survivors remained RRT-dependent and 31% were still hospitalized. On multivariable analysis, people aged over 70 had higher mortality (odds ratio (OR) 2.4, 95% CI: 1.3, 4.6). Cases from the second versus the first COVID-19 wave were older, had more baseline co-morbidity, and were more likely to initiate RRT over 2 weeks after SARS-CoV-2 diagnosis (34% vs 14%, p < 0.001).

Conclusions

AKI-RRT is common in COVID-19 ICU admissions. Residency in areas with high ethnocultural composition and lower socioeconomic status are strong risk factors. Late onset AKI-RRT was more common in the second wave. Mortality is high and 90-day survivors have persisting high morbidity. Graphical Abstract Graphical Abstract

SUBMITTER: Roushani J

PROVIDER: S-EPMC8690186 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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.