Characteristics, outcomes and 60-day hospital mortality of ICU patients with Covid-19 and acute kidney injury

Background: Acute kidney injury (AKI) has been reported in patients with Covid-19 pneumonia and is associated with higher mortality. The aim of our study is to describe characteristics, outcomes and 60-day hospital mortality of patients with Covid-19 pneumonia and AKI in the intensive care unit (ICU). Methods: We conducted a retrospective study in which all adult patients with confirmed Covid-19 admitted to ICUs of Montefiore Medical Center and developing AKI were included. The study period ranged from March 10 - April 11, 2020. Sixty-day follow up data through June 11, 2020 were obtained. Results: Of 300 adults admitted to the ICUs with Covid-19 pneumonia, 224 patients (74.6%) presented with or developed AKI subsequent to admission. Two hundred eighteen (97%) patients required invasive mechanical ventilation for moderate to severe acute respiratory distress syndrome (ARDS). 113 (50.45%) patients had AKI on day 1 of ICU admission. Peak AKI stages observed were stage 1 in 49 (21.8%), 2 in 35 (15.6%) and 3 in 140 (62.5%) patients, respectively. Among patients with AKI, 114 patients (50.8%) required renal replacement therapy (RRT). Mortality rate of patients requiring RRT was 70%. Of the 34 patients who were survivors, 25 (73.5%) were able to be weaned off RRT completely before hospital discharge. Non-survivors were older and had significantly higher admission and peak creatinine levels, admission hemoglobin and peak phosphate levels compared to survivors. The 60-day hospital mortality was 66.5%. Conclusions: Covid-19 requiring ICU admission is associated with high incidence of severe AKI, necessitating RRT in approximately half of such patients. The majority of Covid-19 patients with AKI in ICU developed moderate to severe ARDS requiring invasive mechanical ventilation. Timing or severity of AKI did not affect outcomes. Sixty-day hospital mortality is high (66.5%). AKI patients requiring RRT have high mortality, but survivors have good rates of RRT recovery.