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Kidney Week

Abstract: PO0740

Outpatient Initiation of Dialysis for AKI Requiring Dialysis Following Diagnosis of COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Kubisiak, Kristine, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Dalrymple, Lorien S., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Ofsthun, Norma J., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Sun, Yuping, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States
Background

COVID-19 has been associated with the development of AKI, and the incidence of AKI-D may be as high as 3-5% in patients hospitalized with COVID-19. We examined the initiation of outpatient (OP) dialysis for AKI-D following a diagnosis of COVID-19.

Methods

We identified patients who were diagnosed with COVID-19 prior to initiating OP dialysis for AKI-D in a Fresenius Medical Care North America (FMCNA) dialysis facility between March 30, 2020 and May 22, 2020. COVID-19 diagnosis was based on information provided at the time of referral or data collected within FMCNA. We assessed demographics, geographic location, and select initial outpatient lab values. We followed patients from initiation of OP dialysis until the earliest of recovery of kidney function, transition to ESKD, death, loss to follow-up (typically, transfer to another dialysis provider), or May 24, 2020, and estimated the cumulative incidence of these outcomes.

Results

The cohort comprised 127 patients who were diagnosed with COVID-19 prior to initiating OP dialysis for AKI-D. Mean age was 56.3 ± 14.7 years and 64% were male. Initiation of OP dialysis for AKI-D was observed in regions with a known high incidence of COVID-19 disease (Figure). The median hemoglobin, platelet count and albumin at dialysis initiation were 8.9 g/dL, 271,000 per microliter, and 3.2 g/dL, respectively. During a median follow-up period of 19 days, 18 (14.2%) patients recovered kidney function, 2 (1.6%) transitioned to ESKD, and 2 (1.6%) died.

Conclusion

In an approximate 7-week period, 127 adults started OP dialysis for AKI-D following a diagnosis of COVID-19. Unfortunately, information regarding the clinical course of COVID-19 preceding OP initiation of dialysis was not available and using information at the time of referral may have resulted in misclassification of COVID-19 disease. Nevertheless, these are important findings and warrant further study, especially with respect to long-term outcomes in this population.

Funding

  • Commercial Support