Blood Purification

Research Article

Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil

Doher M.P.a · Torres de Carvalho F.R.b · Scherer P.F.a,b · Matsui T.N.a · Ammirati A.L.a · Caldin da Silva B.b · Barbeiro B.G.a · Carneiro F.D.a · Corrêa T.D.b · Ferraz L.J.R.b · Dos Santos B.F.C.a · Pereira V.G.a · Batista M.C.a,c · Monte J.C.M.a · Santos O.F.P.a,c · Bellomo R.d · Serpa Neto A.b · Durão M.S.a,c,e

Author affiliations

aNephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
bDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
cNephrology Division, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, São Paulo, Brazil
dDepartment of Intensive Care, Austin Hospital, Heidelberg, Melbourne, NSW, Australia
eKidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

Keywords: COVID-19Severe acute respiratory syndrome coronavirus 2Acute kidney injuryDialysisIntensive care unitContinuous renal replacement therapy

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Blood Purif 2021;50:520–530
https://doi.org/10.1159/000513425

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Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: August 31, 2020
Accepted: November 27, 2020
Published online: December 18, 2020
Issue release date: July 2021

Number of Print Pages: 11
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Background: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. Methods: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. Results: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33–4.69], p = 0.005), diuretic use (OR 4.14 [1.27–13.49], p = 0.019), and IMV (OR 7.60 [1.37–42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16–4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04–7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01–4.85], p = 0.047)}. Conclusions: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.

© 2020 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: August 31, 2020
Accepted: November 27, 2020
Published online: December 18, 2020
Issue release date: July 2021

Number of Print Pages: 11
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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