High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy.
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Stevens Jacob S, King Kristen L, Robbins-Juarez Shelief Y, Khairallah Pascale, Toma Katherine, Alvarado Verduzco Hector, Daniel Emily, Douglas Denzil, Moses Andrew A, Peleg Yonatan, Starakiewicz Piotr, Li Miah T, Kim Daniel W, Yu Kathleen, Qian Long, Shah Vaqar H, O'Donnell Max R, Cummings Matthew J, Zucker Jason, Natarajan Karthik, Perotte Adler, Tsapepas Demetra, Krzysztof Kiryluk, Dube Geoffrey, Siddall Eric, Shirazian Shayan, Nickolas Thomas L, Rao Maya K, Barasch Jonathan M, Valeri Anthony M, Radhakrishnan Jai, Gharavi Ali G, Husain S Ali, Mohan Sumit
Аннотация
METHODS: 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.
RESULTS: 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).
CONCLUSIONS AND RELEVANCE: 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.