AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19.
(Journal Article;Multicenter Study)
BACKGROUND: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). METHODS: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. RESULTS: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. CONCLUSIONS: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.
Gupta, S; Coca, SG; Chan, L; Melamed, ML; Brenner, SK; Hayek, SS; Sutherland, A; Puri, S; Srivastava, A; Leonberg-Yoo, A; Shehata, AM; Flythe, JE; Rashidi, A; Schenck, EJ; Goyal, N; Hedayati, SS; Dy, R; Bansal, A; Athavale, A; Nguyen, HB; Vijayan, A; Charytan, DM; Schulze, CE; Joo, MJ; Friedman, AN; Zhang, J; Sosa, MA; Judd, E; Velez, JCQ; Mallappallil, M; Redfern, RE; Bansal, AD; Neyra, JA; Liu, KD; Renaghan, AD; Christov, M; Molnar, MZ; Sharma, S; Kamal, O; Boateng, JO; Short, SAP; Admon, AJ; Sise, ME; Wang, W; Parikh, CR; Leaf, DE; STOP-COVID Investigators,
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