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

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