Fluid Resuscitation and Progression to Renal Replacement Therapy in Patients with COVID-19

Abstract Background Coronavirus disease (COVID-19) is associated with respiratory symptoms and renal effects. Data regarding fluid resuscitation and kidney injury in COVID-19 is lacking and understanding this relationship is critical. Objectives To determine if there is an association between fluid volume administered in 24 hours and development of renal failure in COVID-19 patients. Methods Retrospective chart review; 14 hospitals in Indiana. Included patients ≥18 years old, admitted between March 11, 2020 and April 13, 2020 with a positive test for SARS-CoV-2 within 3 days of admission. Patients requiring renal replacement therapy prior to admission were excluded. Volumes and types of resuscitative intravenous fluids in the first 24 hours were obtained with demographics, medical history, and other objective data. The primary outcome was initiation of renal replacement therapy. Logistic regression modeling was utilized in creating multivariate models for determining factors associated with the primary outcome. Results The fluid volume received in the first 24 hours from hospital admission was associated with initiation of renal replacement therapy in two different multi-variate logistic regression models. An odds ratio of 1.42 (CI 1.01 – 1.99) was observed when adjusting for age, heart failure, obesity, creatinine, bicarbonate, and total fluid volume. An odds ratio of 1.45 (CI 1.02 – 2.05) was observed when variables significant in univariate analysis were adjusted for. Conclusions Each liter of intravenous fluid administered to patients with COVID-19 in the first 24 hours of presentation was independently associated with an increased risk for initiation of renal replacement therapy, supporting judicious fluid administration in patient with this disease.