eGFR, urine output linked with lack of kidney recovery among ICU patients with COVID-19
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A lower baseline eGFR and reduced urine output at the start of kidney replacement therapy “are strongly and independently” correlated with lack of kidney recovery among critically ill patients with COVID-19.
Further, greater AKI severity was associated with increased in-hospital morality or worsened kidney function at discharge.
“AKI occurs frequently in patients with coronavirus disease 2019 (COVID-19), affecting 17% to 46% of hospitalized patients, 14% to 20% of whom are treated with kidney replacement therapy (KRT),” Caroline M. Hsu, MD, from Tufts Medical Center at Tufts University in Boston, Massachusetts, and colleagues wrote. “Using detailed clinical data from a large multicenter cohort of critically ill patients with COVID-19, we first investigated the association of AKI severity with kidney function at the time of hospital discharge. Next, among patients with AKI-KRT, we examined the clinical factors that may predict kidney recovery, using baseline characteristics and measures of clinical status at the time of dialysis initiation.”
In a multicenter cohort study, researchers evaluated 4,221 adults (ICU cohort) admitted to ICUs at 68 U.S. hospitals with COVID-19 between March 1 and June 22, 2020. No patients received kidney transplant therapy, but 876 developed AKI-KRT after hospital submission (AKI-KRT subcohort).
Using descriptive analyses and AKI severity as the exposure, researchers characterized the ICU cohort. Researchers used descriptive analyses and multinomial logistic regression to characterize and measure factors correlated with kidneys that did not recover while accounting for death in the AKI-KRT subcohort.
Researchers considered demographics, comorbidities, initial mode of KRT and markers of illness severity at the start of KRT to be exposures among the AKI-KRT cohort.
Among the 4,221 patients in the ICU cohort, 2,361 developed AKI. Of the 876 patients with AKI-KRT, 588 died, 95 had kidneys that did not recover and 193 experienced kidney recovery by the time of discharge. Researchers determined that greater AKI severity correlated with increased in-hospital mortality and worse kidney function at discharge. Additionally, multiple analyses revealed lower baseline eGFR and oligoanuria at dialysis initiation correlated with lower odds of recovery from AKI-KRT.
“The magnitude of the associations presented here may assist prognostication of long-term dialysis treatment, which carries implications for patients’ physical health and quality of life,” Hsu and colleagues wrote. They added, “Compared to prior studies of AKI-KRT among critically ill patients without COVID-19, this study and other studies of patients with COVID-19 have found higher rates of in-hospital mortality and of ongoing treatment with dialysis at hospital discharge.”
According to the study, limitations included a lack of follow-up after discharge. Therefore, additional recovery events could be possible.
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