AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19

被引：219

作者：

Gupta, Shruti ^{[1
]}

Coca, Steven G. ^{[2
]}

Chan, Lili ^{[2
]}

Melamed, Michal L. ^{[3
]}

Brenner, Samantha K. ^{[4
,5
]}

Hayek, Salim S. ^{[6
]}

Sutherland, Anne ^{[7
]}

Puri, Sonika ^{[8
]}

Srivastava, Anand ^{[9
]}

Leonberg-Yoo, Amanda ^{[10
]}

Shehata, Alexandre M. ^{[11
]}

Flythe, Jennifer E. ^{[12
,13
]}

Rashidi, Arash ^{[14
]}

Schenck, Edward J. ^{[15
]}

Goyal, Nitender ^{[16
]}

Hedayati, S. Susan ^{[17
]}

Dy, Rajany ^{[18
]}

Bansal, Anip ^{[19
]}

Athavale, Ambarish ^{[20
]}

Nguyen, H. Bryant ^{[21
]}

Vijayan, Anitha ^{[22
]}

Charytan, David M. ^{[23
]}

Schulze, Carl E. ^{[24
]}

Joo, Min J. ^{[25
]}

Friedman, Allon N. ^{[26
]}

Zhang, Jingjing ^{[27
]}

Sosa, Marie Anne ^{[28
,29
]}

Judd, Eric ^{[30
]}

Velez, Juan Carlos Q. ^{[31
,32
]}

Mallappallil, Mary ^{[33
]}

Redfern, Roberta E. ^{[34
]}

Bansal, Amar D. ^{[35
]}

Neyra, Javier A. ^{[36
]}

Liu, Kathleen D. ^{[37
]}

Renaghan, Amanda D. ^{[38
]}

Christov, Marta ^{[39
]}

Molnar, Miklos Z. ^{[40
]}

Sharma, Shreyak ^{[1
]}

Kamal, Omer ^{[1
]}

Boateng, Jeffery Owusu ^{[41
]}

Short, Samuel A. P. ^{[42
]}

Admon, Andrew J. ^{[43
]}

Sise, Meghan E. ^{[44
]}

Wang, Wei ^{[45
,46
]}

Parikh, Chirag R. ^{[47
]}

Leaf, David E. ^{[1
]}

机构：

[1] Brigham & Womens Hosp, Div Renal Med, 75 Francis St, Boston, MA 02115 USA

[2] Icahn Sch Med Mt Sinai, Dept Med, Div Nephrol, New York, NY 10029 USA

[3] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA

[4] Hackensack Meridian Sch Med, Dept Internal Med, Seton Hall, Nutley, NJ USA

[5] Hackensack Meridian Hlth Hackensack Univ, Med Ctr, Dept Internal Med, Heart & Vasc Hosp, Hackensack, NJ USA

[6] Univ Michigan, Med Ctr, Div Cardiol, Ann Arbor, MI USA

[7] Rutgers New Jersey Med Sch, Div Pulm & Crit Care Med, Newark, NJ USA

[8] Rutgers Robert Wood Johnson Med Sch, Div Nephrol, New Brunswick, NJ USA

[9] Northwestern Univ, Inst Publ Hlth & Med, Div Nephrol & Hypertens, Ctr Translat Metab & Hlth,Feinberg Sch Med, Chicago, IL 60611 USA

[10] Univ Penn, Perelman Sch Med, Renal Electrolyte & Hypertens Div, Philadelphia, PA 19104 USA

[11] Hackensack Meridian Hlth Mountainside Med Ctr, Dept Med, Glen Ridge, NJ USA

[12] Univ N Carolina, Sch Med, Dept Med, Div Nephrol & Hypertens,Kidney Ctr, Chapel Hill, NC 27515 USA

[13] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27515 USA

[14] Univ Hosp Cleveland, Med Ctr, Div Nephrol & Hypertens, Cleveland, OH 44106 USA

[15] Weill Cornell Med, Dept Med, Div Pulm & Crit Care Med, New York, NY USA

[16] Tufts Med Ctr, Div Nephrol, Boston, MA 02111 USA

[17] Univ Texas Southwestern Med Ctr Dallas, Dept Med, Div Nephrol, Dallas, TX 75390 USA

[18] Univ Nevada, Univ Med Ctr, Div Pulm & Crit Care Med, Las Vegas, NV 89154 USA

[19] Univ Colorado, Div Renal Dis & Hypertens, Anschutz Med Campus, Aurora, CO USA

[20] Cook Cty Hlth, Div Nephrol, Chicago, IL USA

[21] Loma Linda Univ Hlth, Div Pulm Crit Care Hyperbar Allergy & Sleep Med, Loma Linda, CA USA

[22] Washington Univ, Div Nephrol, St Louis, MO 63110 USA

[23] NYU, Grossman Sch Med, Div Nephrol, New York, NY USA

[24] Univ Calif Los Angeles, Dept Med, Div Nephrol, Los Angeles, CA 90024 USA

[25] Univ Illinois, Dept Med, Sect Pulm Crit Care Sleep & Allergy, Chicago, IL USA

[26] Indiana Univ Sch Med, Dept Med, Indianapolis, IN 46202 USA

[27] Thomas Jefferson Univ Hosp, Div Nephrol, Philadelphia, PA 19107 USA

[28] Univ Miami, Miller Sch Med, Dept Med, Div Nephrol, Miami, FL 33136 USA

[29] Jackson Mem Hosp, Miami, FL 33136 USA

[30] Univ Alabama Birmingham, Div Nephrol, Birmingham, AL USA

[31] Ochsner Hlth Syst, Dept Nephrol, New Orleans, LA USA

[32] Univ Queensland, Ochsner Clin Sch, Brisbane, Qld, Australia

[33] New York City Hlth & Hosp Corp, Kings Cty Hosp Ctr, Div Nephrol, Brooklyn, NY USA

[34] ProMed Toledo Hosp, Res Dept, ProMed Res, Toledo, OH USA

[35] Univ Pittsburgh, Med Ctr, Renal & Electrolyte Div, Pittsburgh, PA USA

[36] Univ Kentucky, Dept Internal Med Bone & Mineral Metab, Div Nephrol, Lexington, KY USA

[37] Univ Calif San Francisco, Div Nephrol & Crit Care Med, San Francisco, CA 94143 USA

[38] Univ Virginia Hlth Syst, Div Nephrol, Charlottesville, VA USA

[39] New York Med Coll, Westchester Med Ctr, Dept Med Nephrol, New York, NY USA

[40] Univ Tennessee, Hlth Sci Ctr, Dept Surg, Memphis, TN USA

[41] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[42] Univ Vermont, Larner Coll Med, Burlington, VT USA

[43] Univ Michigan, Dept Internal Med, Div Pulm & Crit Care Med, Ann Arbor, MI 48109 USA

[44] Massachusetts Gen Hosp, Dept Med, Div Nephrol, Boston, MA 02114 USA

[45] Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA

[46] Brigham & Womens Hosp, Dept Neurol, 75 Francis St, Boston, MA 02115 USA

[47] Johns Hopkins Sch Med, Div Nephrol, Baltimore, MD USA

来源：

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2021年 / 32卷 / 01期

基金：

美国国家卫生研究院;

关键词：

acute renal failure; clinical epidemiology; dialysis; risk factors; COVID-19; renal replacement therapy; acute kidney injury; ACUTE KIDNEY INJURY; END-POINTS; FAILURE; RISK; VOLUME; EPIDEMIOLOGY; MORTALITY; OUTCOMES; SEPSIS; DEATH;

D O I：

10.1681/ASN.2020060897

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

100201 [内科学]; 100221 [泌尿外科学];

摘要：

Background AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, fewstudies have focused on AKI treated with RRT (AKI- RRT). Methods We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. Results A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher D-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKIRRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. Conclusions AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of.60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.

引用

页码：161 / 176

页数：16

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