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Kidney Week

Abstract: PO0812

COVID-19 Short-Term Outcomes of AKI and Chronic Hemodialysis

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Smolander, Jessica, Danderyds Sjukhus AB, Stockholm, Sweden
  • Bruchfeld, Annette, Karolinska Universitetssjukhuset, Stockholm, Sweden
Introduction


Acute kidney injury (AKI), albuminuria and hematuria are common and increase mortality in Covid-19 in addition to viral pneumonia, hypercoagulability and hyperinflammation. We present short-term outcomes of 21 Covid-19 patients with AKI and CRRT and the clinical course of 40 chronic hemodialysis (HD) patients with Covid-19.

Case Description

Twenty-one non-CKD Covid-19 infected patients with AKI required mechanical ventilation and CRRT at the ICU, 20 were males, average age was 59.7 years (y), average BMI 29 kg/m2, 33 % had diabetes. The typical scenario was a normal/slightly elevated creatinine level at admission, normalizing after iv fluids, but rising creatinine from day 3-4 and start of CRRT on day 8 (median). Urine analysis was available in eight patients, of which seven had albuminuria and/or hematuria. So far eight patients (38 %) have died. Dialysis has been discontinued in nine patients (43 %), median time 17 days in dialysis (range 1-35 days), follow up of 1-4 weeks. Patients 3-4 weeks after CRRT discontinuation have a creatinine level of 50-161 μmol/L (ref < 90-100 μmol/L). Four patients are still dialysis dependent (median time in dialysis 7-22 days).
Forty out of 520 patients on chronic HD in Stockholm had symptomatic Covid-19 in March-April 2020, of these 24 patients (60 %) required hospitalization, 16 patients (40%) did not. Nine patients died (22,5 %), of whom eight were men. The average age (78 y) was significantly higher (p = 0.003) and median time in dialysis (11.5 y) was longer (p = 0.01) in the non-survivors compared to the survivors. CRP at admission was significantly higher in the non-survivors (p=0.0003), but there were no differences regarding prior cardiovascular disease or diabetes (56 vs 55 %). Only three patients had a BMI > 30 kg/m2. Among survivors, the number of patients with ACE inhibitor/ARB treatment did not differ from non-survivors (p = 0.08), 13 out of 15 patients continued their treatment, without more serious disease.

Discussion


The AKI mortality in Covid-19 with CRRT is high, but a substantial number of patients have survived and recovered kidney function although follow-up for long-term CKD prognosis is important. Fewer chronic HD patients than expected suffered severe disease, however patients older than 70 y in combination with longer time (> 10 y) in HD and high CRP at admission were at a higher risk of dying from symptomatic Covid-19.