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Outcomes of critically ill coronavirus disease 2019 patients requiring kidney replacement therapy: A retrospective

Josephine Braunsteiner1, Dominik Jarczak1, Christian Schmidt-Lauber2

  • 1Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Frontiers in Medicine
|November 7, 2022
PubMed

Insights

Nearly half of critically ill COVID-19 patients require kidney replacement therapy (KRT). This KRT initiation is linked to significantly higher intensive care unit (ICU) mortality rates.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is a significant global health crisis with high hospitalization rates.
  • Acute kidney injury (AKI) is a common complication in COVID-19 patients, correlating with disease severity and adverse outcomes.
  • Understanding the need for kidney replacement therapy (KRT) and its impact on outcomes in critically ill COVID-19 patients is crucial.

Purpose of the Study:

  • To determine the incidence of kidney replacement therapy (KRT) among critically ill patients with COVID-19.
  • To investigate the factors associated with the initiation of KRT in this patient population.
  • To evaluate the implication of KRT on mortality in critically ill COVID-19 patients.

Main Methods:

  • Retrospective analysis of COVID-19 patients admitted to the Intensive Care Medicine department.
  • Data collection included demographics, clinical parameters, organ support, ICU stay length, mortality, and severity scores.
  • Statistical analysis, including logistic and Cox regression, was used to identify factors associated with KRT and mortality.

Main Results:

  • Out of 300 critically ill COVID-19 patients, 46% required KRT.
  • Factors independently associated with KRT initiation included septic shock, higher SAPS II scores, and vasopressor therapy.
  • Mortality in the ICU was significantly higher for patients who received KRT (61%) compared to those who did not (18%).

Conclusions:

  • Critically ill COVID-19 patients face a high risk of AKI, with approximately half requiring KRT.
  • KRT initiation in this cohort is independently associated with increased ICU mortality.
  • Early identification and management of AKI risk factors in COVID-19 patients are essential.
Abstract

Keywords:
AKIARDSCOVID-19ECMOSARS-CoV-2kidney replacement therapy (KRT)multiple organ failurerenal replacement therapy (RRT)

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