Journal Article

The Impact of Chronic Kidney Disease on In‐Hospital Outcomes in Patients With Acute Respiratory Distress Syndrome

Kichloo, Asim, Karki, Apurwa, Anwar, Ayesha, Agrawal, Akriti, Singh, Jagmeet, Rao, Adishwar

2026

Overview

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates in critically ill patients. Renopulmonary interplay remains crucial in contributing to the outcomes in patients with ARDS. While the role of acute kidney injury has been widely explored in these patients, there remains an unmet need in the literature about the impact of chronic kidney disease (CKD) in these patients. Is there a quantifiable association between CKD and in-hospital outcomes in patients with ARDS? We utilized a retrospective study design to compare descriptive statistics and outcomes in patients with ARDS with or without CKD. Pearson's chi-square test was used to compare categorical variables, while the Wilcoxon rank sum test was used for continuous variables. We also performed multivariate logistic regression analyses for each outcome and adjusted for demographics and comorbidities. Lastly, we conducted a sensitivity analysis using propensity score-matched outcomes between these groups. Among 479,450 patients with ARDS, 17.6% also had CKD, while 82.4% did not. Patients with ARDS and CKD were older (median age: 71 years vs. 60 years, < 0.001) and comprised a greater proportion of males (59.4% vs. 55.9%, < 0.001). CKD was associated with increased odds of in-hospital mortality (adjusted odds ratio [aOR] 1.29, < 0.001), acute heart failure (aOR 1.26, < 0.001), ventricular arrhythmias (aOR 1.16, < 0.001), cardiogenic shock (aOR 1.10, = 0.044), major adverse cardiovascular events (aOR 1.29, < 0.001), and length of stay ≥ 7 days (aOR 1.05, = 0.033). Our study provides insights into the magnitude of impact renal diseases may have on the outcomes of patients with ARDS. Further prospective studies are warranted to establish more substantial epidemiological evidence of this relationship to tailor the management of such patients.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Acute respiratory distress syndrome / Aged / Analysis / Care and treatment / Chronic kidney failure / COVID-19 / Female / Hospital Mortality / Humans / Kidney diseases / Male / Medical research / Medicine, Experimental / Middle Aged / Mortality / Patient outcomes / Physiological aspects / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - epidemiology / Renal Insufficiency, Chronic - mortality / Respiratory Distress Syndrome - complications / Respiratory Distress Syndrome - mortality / Retrospective Studies / Sleep apnea