Acute kidney injury and renal replacement therapy in critically ill COVID-19 patients: Risk factors and outcomes: A single-center experience in Brazil

Marisa Petrucelli Doher, Fabrício Rodrigues Torres De Carvalho, Patrícia Faria Scherer, Thaís Nemoto Matsui, Adriano Luiz Ammirati, Bruno Caldin Da Silva, Bruna Gomes Barbeiro, Fabiana Dias Carneiro, Thiago Domingos Corrêa, Leonardo José Rolim Ferraz, Bento Fortunato Cardoso Dos Santos, Virgílio Gonçalves Pereira, Marcelo Costa Batista, Júlio Cesar Martins Monte, Oscar Fernando Pavão Santos, Rinaldo Bellomo, Ary Serpa Neto, Marcelino D. De Souza Durão

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40 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)520–530
Number of pages11
JournalBlood Purification
Issue number4-5
Publication statusPublished - Jul 2021
Externally publishedYes


  • Acute kidney injury
  • Continuous renal replacement therapy
  • COVID-19
  • Dialysis
  • Intensive care unit
  • Severe acute respiratory syndrome coronavirus 2

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