Journal Article

High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Nickolas, Thomas L., Kim, Daniel W., Dube, Geoffrey, Krzysztof, Kiryluk, Toma, Katherine, Cummings, Matthew J., Natarajan, Karthik, Starakiewicz, Piotr, Tsapepas, Demetra, Rao, Maya K., Barasch, Jonathan M., Perotte, Adler, Stevens, Jacob S., Shirazian, Shayan, Husain, S. Ali, Zucker, Jason, Siddall, Eric, Douglas, Denzil, Li, Miah T., Radhakrishnan, Jai, Alvarado Verduzco, Hector, Gharavi, Ali G., Valeri, Anthony M., Khairallah, Pascale, Moses, Andrew A., O'Donnell, Max R., Yu, Kathleen, King, Kristen L., Daniel, Emily, Shah, Vaqar H., Peleg, Yonatan, Robbins-Juarez, Shelief Y., Mohan, Sumit, Qian, Long

2020

Overview

A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute Kidney Injury - etiology / Acute Kidney Injury - pathology / Acute Kidney Injury - virology / Acute renal failure / Aged / Angiotensin / Biology and Life Sciences / Care and treatment / Chronic obstructive pulmonary disease / Coronary artery / Coronary artery disease / Coronaviruses / COVID-19 / COVID-19 - complications / Critical care / Critical Illness - mortality / Decision making / Diabetes / Enzyme inhibitors / Epidemiology / Female / Health care facilities / Heart diseases / Humans / Informatics / Intensive Care Units / Kidney - pathology / Kidney - virology / Kidneys / Lung diseases / Male / Mechanical ventilation / Medical prognosis / Medicine / Medicine and Health Sciences / Middle Aged / Mortality / Nephrology / New York City / Obstructive lung disease / Patient outcomes / Patients / Peptidyl-dipeptidase A / Proportional Hazards Models / Recovery / Recovery (Medical) / Renal failure / Renal Replacement Therapy - methods / Retrospective Studies / SARS-CoV-2 - pathogenicity / Severe acute respiratory syndrome coronavirus 2 / Shared decision making / Supervision / Survival / Survivors / Ventilation