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Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.

Publication ,  Journal Article
Flythe, JE; Assimon, MM; Tugman, MJ; Chang, EH; Gupta, S; Shah, J; Sosa, MA; Renaghan, AD; Melamed, ML; Wilson, FP; Neyra, JA; Rashidi, A ...
Published in: Am J Kidney Dis
February 2021

RATIONALE & OBJECTIVE: Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. STUDY DESIGN: Retrospective cohort study. SETTINGS & PARTICIPANTS: 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States. PREDICTOR(S): Presence (vs absence) of pre-existing kidney disease. OUTCOME(S): In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary). ANALYTICAL APPROACH: We used standardized differences to compare patient characteristics (values>0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations. RESULTS: Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference=0.12) and those without pre-existing CKD (12%; standardized difference=0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). LIMITATIONS: Potential residual confounding. CONCLUSIONS: Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.

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Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

February 2021

Volume

77

Issue

2

Start / End Page

190 / 203.e1

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Treatment Outcome
  • SARS-CoV-2
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Male
  • Kidney Function Tests
 

Citation

APA
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ICMJE
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Flythe, J. E., Assimon, M. M., Tugman, M. J., Chang, E. H., Gupta, S., Shah, J., … STOP-COVID Investigators, . (2021). Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States. Am J Kidney Dis, 77(2), 190-203.e1. https://doi.org/10.1053/j.ajkd.2020.09.003
Flythe, Jennifer E., Magdalene M. Assimon, Matthew J. Tugman, Emily H. Chang, Shruti Gupta, Jatan Shah, Marie Anne Sosa, et al. “Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.Am J Kidney Dis 77, no. 2 (February 2021): 190-203.e1. https://doi.org/10.1053/j.ajkd.2020.09.003.
Flythe JE, Assimon MM, Tugman MJ, Chang EH, Gupta S, Shah J, et al. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States. Am J Kidney Dis. 2021 Feb;77(2):190-203.e1.
Flythe, Jennifer E., et al. “Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.Am J Kidney Dis, vol. 77, no. 2, Feb. 2021, pp. 190-203.e1. Pubmed, doi:10.1053/j.ajkd.2020.09.003.
Flythe JE, Assimon MM, Tugman MJ, Chang EH, Gupta S, Shah J, Sosa MA, Renaghan AD, Melamed ML, Wilson FP, Neyra JA, Rashidi A, Boyle SM, Anand S, Christov M, Thomas LF, Edmonston D, Leaf DE, STOP-COVID Investigators. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States. Am J Kidney Dis. 2021 Feb;77(2):190-203.e1.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

February 2021

Volume

77

Issue

2

Start / End Page

190 / 203.e1

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Treatment Outcome
  • SARS-CoV-2
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Male
  • Kidney Function Tests