TY - JOUR
T1 - Acute kidney injury and renal replacement therapy in critically ill COVID-19 patients
T2 - Risk factors and outcomes: A single-center experience in Brazil
AU - Doher, Marisa Petrucelli
AU - Torres De Carvalho, Fabrício Rodrigues
AU - Scherer, Patrícia Faria
AU - Matsui, Thaís Nemoto
AU - Ammirati, Adriano Luiz
AU - Caldin Da Silva, Bruno
AU - Barbeiro, Bruna Gomes
AU - Carneiro, Fabiana Dias
AU - Corrêa, Thiago Domingos
AU - Ferraz, Leonardo José Rolim
AU - Dos Santos, Bento Fortunato Cardoso
AU - Pereira, Virgílio Gonçalves
AU - Batista, Marcelo Costa
AU - Monte, Júlio Cesar Martins
AU - Santos, Oscar Fernando Pavão
AU - Bellomo, Rinaldo
AU - Serpa Neto, Ary
AU - De Souza Durão, Marcelino D.
PY - 2021/7
Y1 - 2021/7
N2 - Background: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. Methods: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. Results: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33-4.69], p = 0.005), diuretic use (OR 4.14 [1.27-13.49], p = 0.019), and IMV (OR 7.60 [1.37-42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16-4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04-7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01-4.85], p = 0.047)}. Conclusions: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.
AB - Background: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. Methods: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. Results: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33-4.69], p = 0.005), diuretic use (OR 4.14 [1.27-13.49], p = 0.019), and IMV (OR 7.60 [1.37-42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16-4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04-7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01-4.85], p = 0.047)}. Conclusions: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.
KW - Acute kidney injury
KW - Continuous renal replacement therapy
KW - COVID-19
KW - Dialysis
KW - Intensive care unit
KW - Severe acute respiratory syndrome coronavirus 2
UR - http://www.scopus.com/inward/record.url?scp=85098119896&partnerID=8YFLogxK
U2 - 10.1159/000513425
DO - 10.1159/000513425
M3 - Article
C2 - 33341806
AN - SCOPUS:85098119896
VL - 50
SP - 520
EP - 530
JO - Blood Purification
JF - Blood Purification
SN - 0253-5068
IS - 4-5
ER -