AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
Shruti Gupta, Steven G Coca, Lili Chan, Michal L Melamed, Samantha K Brenner, Salim S Hayek, Anne Sutherland, Sonika Puri, Anand Srivastava, Amanda Leonberg-Yoo, Alexandre M Shehata, Jennifer E Flythe, Arash Rashidi, Edward J Schenck, Nitender Goyal, S Susan Hedayati, Rajany Dy, Anip Bansal, Ambarish Athavale, H Bryant Nguyen, Anitha Vijayan, David M Charytan, Carl E Schulze, Min J Joo, Allon N Friedman, Jingjing Zhang, Marie Anne Sosa, Eric Judd, Juan Carlos Q Velez, Mary Mallappallil, Roberta E Redfern, Amar D Bansal, Javier A Neyra, Kathleen D Liu, Amanda D Renaghan, Marta Christov, Miklos Z Molnar, Shreyak Sharma, Omer Kamal, Jeffery Owusu Boateng, Samuel A P Short, Andrew J Admon, Meghan E Sise, Wei Wang, Chirag R Parikh, David E Leaf, and the STOP-COVID Investigators, Carl P Walther, Samaya J Anumudu, Justin Arunthamakun, Kathleen F Kopecky, Gregory P Milligan, Peter A McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D Valencia, Sushrut S Waikar, Zoe A Kibbelaar, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Adam Green, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L Edmonston, Christopher L Mosher, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor Ul Aain Bhatti, Bijal Mehta, Aquino Williams, Patricia Walters, Ronaldo C Go, Keith M Rose, Rebecca Lisk, Amy M Zhou, Ethan C Kim, Kusum S Mathews, Deena R Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A Leven, Jing G Wang, Gohar Mosoyan, Girish N Nadkarni, Pattharawin Pattharanitima, Emily J Gallagher, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J Kelly, Brian T Garibaldi, Celia P Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F Malik, Carmen Elena Cervantes, Samir C Gautam, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, Afshin Ahoubim, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Yan Zhou, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G Kassaye, Tanya S Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Neelja Kumar, Michael Chang, Jyotsana Thakkar, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Soo Jung Cho, Maria Plataki, Sergio L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, Ashley Macina, Sobaata Chaudhry, Benjamin Wu, Frank Modersitzki, Amey Bhivshet, Alexander S Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Eboni G Price-Haywood, Luis A Matute-Trochez, Anna E Hasty, Muner M B Mohamed, Rupali S Avasare, David Zonies, Erik T Newman, Samah Abu Omar, Kapil K Pokharel, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Heather Yang Meghan Lee, Ian A Strohbehn, Jiahua Li, Ariel L Mueller, Nicholas S Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffrey M Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S Vatson, Shuchi Anand, Joseph E Levitt, Pablo Garcia, Suzanne M Boyle, Rui Song, Ali Arif, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Katharine Senter, Moh'd A Sharshir, Vadym V Rusnak, Muhammad Imran Ali, Terri Peters, Kathy Hughes, Amber S Podoll, Michel Chonchol, Sunita Sharma, Ellen L Burnham, Rana Hejal, Laura Latta, Ashita Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Etienne Macedo, Harin Rhee, Vasantha K Jotwani, Jay L Koyner, Chintan V Shah, Vishal Jaikaransingh, Stephanie M Toth-Manikowski, James P Lash, Nourhan Chaaban, Yahya Ahmad, Madona Elias, Alfredo Iardino, Elizabeth H Au, Jill H Sharma, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Alessia Fornoni, Hayley B Gershengorn, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O ' Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Abbas Bitar, Elizabeth Anderson, John P Donnelly, Matthew J Tugman, Emily H Chang, Brent R Brown, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Natalie C Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P Kovesdy, Ambreen Azhar, Mridula V Nadamuni, Shani Shastri, Duwayne L Willett, Kyle B Enfield, Pavan K Bhatraju, A Bilal Malik, Matthew W Semler, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Anthony J Faugno, Greg L Schumaker, Caroline M Hsu, Asma Tariq, Leah Meyer, Ravi K Kshirsagar, Daniel E Weiner, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo, Shruti Gupta, Steven G Coca, Lili Chan, Michal L Melamed, Samantha K Brenner, Salim S Hayek, Anne Sutherland, Sonika Puri, Anand Srivastava, Amanda Leonberg-Yoo, Alexandre M Shehata, Jennifer E Flythe, Arash Rashidi, Edward J Schenck, Nitender Goyal, S Susan Hedayati, Rajany Dy, Anip Bansal, Ambarish Athavale, H Bryant Nguyen, Anitha Vijayan, David M Charytan, Carl E Schulze, Min J Joo, Allon N Friedman, Jingjing Zhang, Marie Anne Sosa, Eric Judd, Juan Carlos Q Velez, Mary Mallappallil, Roberta E Redfern, Amar D Bansal, Javier A Neyra, Kathleen D Liu, Amanda D Renaghan, Marta Christov, Miklos Z Molnar, Shreyak Sharma, Omer Kamal, Jeffery Owusu Boateng, Samuel A P Short, Andrew J Admon, Meghan E Sise, Wei Wang, Chirag R Parikh, David E Leaf, and the STOP-COVID Investigators, Carl P Walther, Samaya J Anumudu, Justin Arunthamakun, Kathleen F Kopecky, Gregory P Milligan, Peter A McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D Valencia, Sushrut S Waikar, Zoe A Kibbelaar, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Adam Green, Jean-Sebastien Rachoin, Christa A Schorr, Lisa Shea, Daniel L Edmonston, Christopher L Mosher, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor Ul Aain Bhatti, Bijal Mehta, Aquino Williams, Patricia Walters, Ronaldo C Go, Keith M Rose, Rebecca Lisk, Amy M Zhou, Ethan C Kim, Kusum S Mathews, Deena R Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A Leven, Jing G Wang, Gohar Mosoyan, Girish N Nadkarni, Pattharawin Pattharanitima, Emily J Gallagher, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J Kelly, Brian T Garibaldi, Celia P Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F Malik, Carmen Elena Cervantes, Samir C Gautam, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, Afshin Ahoubim, Leslie F Thomas, Dheeraj Reddy Sirganagari, Pramod K Guru, Yan Zhou, Paul A Bergl, Jesus Rodriguez, Jatan A Shah, Mrigank S Gupta, Princy N Kumar, Deepa G Lazarous, Seble G Kassaye, Tanya S Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Neelja Kumar, Michael Chang, Jyotsana Thakkar, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Soo Jung Cho, Maria Plataki, Sergio L Alvarez-Mulett, Luis G Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, Ashley Macina, Sobaata Chaudhry, Benjamin Wu, Frank Modersitzki, Amey Bhivshet, Alexander S Leidner, Carlos Martinez, Jacqueline M Kruser, Richard G Wunderink, Alexander J Hodakowski, Eboni G Price-Haywood, Luis A Matute-Trochez, Anna E Hasty, Muner M B Mohamed, Rupali S Avasare, David Zonies, Erik T Newman, Samah Abu Omar, Kapil K Pokharel, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Heather Yang Meghan Lee, Ian A Strohbehn, Jiahua Li, Ariel L Mueller, Nicholas S Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J Byun, Andrew Vissing, Esha M Kapania, Zoe Post, Nilam P Patel, Joy-Marie Hermes, Amee Patrawalla, Diana G Finkel, Barbara A Danek, Sowminya Arikapudi, Jeffrey M Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Jag Sunderram, Matthew T Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S Vatson, Shuchi Anand, Joseph E Levitt, Pablo Garcia, Suzanne M Boyle, Rui Song, Ali Arif, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Katharine Senter, Moh'd A Sharshir, Vadym V Rusnak, Muhammad Imran Ali, Terri Peters, Kathy Hughes, Amber S Podoll, Michel Chonchol, Sunita Sharma, Ellen L Burnham, Rana Hejal, Laura Latta, Ashita Tolwani, Timothy E Albertson, Jason Y Adams, Steven Y Chang, Rebecca M Beutler, Etienne Macedo, Harin Rhee, Vasantha K Jotwani, Jay L Koyner, Chintan V Shah, Vishal Jaikaransingh, Stephanie M Toth-Manikowski, James P Lash, Nourhan Chaaban, Yahya Ahmad, Madona Elias, Alfredo Iardino, Elizabeth H Au, Jill H Sharma, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Alessia Fornoni, Hayley B Gershengorn, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O ' Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Abbas Bitar, Elizabeth Anderson, John P Donnelly, Matthew J Tugman, Emily H Chang, Brent R Brown, Ryan C Spiardi, Todd A Miano, Meaghan S Roche, Charles R Vasquez, Natalie C Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P Kovesdy, Ambreen Azhar, Mridula V Nadamuni, Shani Shastri, Duwayne L Willett, Kyle B Enfield, Pavan K Bhatraju, A Bilal Malik, Matthew W Semler, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F Kao, Greg L Schumaker, Anthony J Faugno, Greg L Schumaker, Caroline M Hsu, Asma Tariq, Leah Meyer, Ravi K Kshirsagar, Daniel E Weiner, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Perry Wilson, Tanima Arora, Ugochukwu Ugwuowo
Abstract
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.
Keywords: COVID-19; acute kidney injury; acute renal failure; clinical epidemiology; dialysis; renal replacement therapy; risk factors.
Copyright © 2021 by the American Society of Nephrology.
Figures
Source: PubMed