AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
Authors: Gupta Shruti , Coca Steven G. , Chan Lili , Melamed Michal L. , Brenner Samantha K. , Hayek Salim S. , Sutherland Anne , Puri Sonika , Srivastava Anand , Leonberg-Yoo Amanda , Shehata Alexandre M. , Flythe Jennifer E. , Rashidi Arash , Schenck Edward J. , Goyal Nitender , Hedayati S. Susan , Dy Rajany , Bansal Anip , Athavale Ambarish , Nguyen H. Bryant , Vijayan Anitha , Charytan David M. , Schulze Carl E. , Joo Min J. , Friedman Allon N. , Zhang Jingjing , Sosa Marie Anne , Judd Eric , Velez Juan Carlos Q. , Mallappallil Mary , Redfern Roberta E. , Bansal Amar D. , Neyra Javier A. , Liu Kathleen D. , Renaghan Amanda D. , Christov Marta , Molnar Miklos Z. , Sharma Shreyak , Kamal Omer , Boateng Jeffery Owusu , Short Samuel A.P. , Admon Andrew J. , Sise Meghan E. , Wang Wei , Parikh Chirag R. , Leaf David E. ,   and the STOP-COVID Investigators
Published: October 2020

Significance Statement
Although AKI is an important sequela of coronavirus disease 2019 (COVID-19), data on AKI treated with RRT (AKI-RRT) in patients with COVID-19 are limited. In 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, one in five patients developed AKI-RRT, 63% of whom died during hospitalization. Among patients who survived to hospital discharge, one in three remained RRT dependent at discharge, and one in six remained RRT dependent 60 days after ICU admission. The study identified several patient-and hospital-level risk factors for AKI-RRT and death. AKI-RRT is common among critically ill patients with COVID-19 and is associated with high mortality and persistent RRT dependence.

Background
AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies 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 AKI-RRT 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.