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Abstract: PO0024

Recovery from AKI Requiring Kidney Replacement Therapy in Critically Ill Patients with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
  • Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Goyal, Nitender, Tufts Medical Center, Boston, Massachusetts, United States
  • Faugno, Anthony John, Tufts Medical Center, Boston, Massachusetts, United States
  • Tariq, Asma, Tufts Medical Center, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
Background

Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) occurs in as many as one in five critically ill patients with COVID-19. Expanding on previous work by this group, we examined the association of clinical factors at the time of KRT initiation with the outcome of kidney recovery at hospital discharge, accounting for the competing outcome of death.

Methods

We used data from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), a multicenter cohort study that enrolled adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 4 to June 22, 2020. Among those who acutely required KRT, the outcome of kidney non-recovery (continued dialysis dependence at hospital discharge) was explored with multinomial logistic regression, with kidney recovery (independence from dialysis at discharge) as the reference outcome and death as an alternate outcome. Exposures of interest included demographics, baseline medical status, and markers of illness acuity at the time of KRT initiation.

Results

Of 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) survived to discharge and remained dependent on KRT, and 193 (22%) survived to discharge without KRT dependence. Patients with lower baseline eGFR had greater odds of kidney non-recovery, with OR 8.58 (95% CI: 3.03-24.28) among patients with eGFR ≤15 vs >60. Reduced urine output on the day of KRT initiation was also associated with kidney non-recovery, with OR 4.23 (95% CI: 1.61-11.15) for urine output <50 mL/day vs >500 mL/day (Figure).

Conclusion

Among critically ill patients with COVID-19 with AKI requiring KRT, lower baseline kidney function and reduced urine output at the time of KRT initiation are associated with kidney non-recovery.

Funding

  • NIDDK Support