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Case fatality rate among COVID-19 patients treated with acute kidney replacement therapy
Gabriel Martins Nogueira1, Paulo Novis Rocha2, Constança Margarida Sampaio Cruz1
1Escola Bahiana de Medicina e Saúde Pública, Departamento de Medicina, Salvador, BA, Brazil.
Insights
Critically ill COVID-19 patients requiring acute kidney replacement therapy (AKRT) in Brazil faced a very high case fatality rate (CFR) of 93%. Most deaths occurred within 10 days of initiating AKRT, highlighting an urgent need for improved strategies.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe COVID-19 frequently causes acute kidney injury (AKI), a condition linked to high mortality.
- Data on case fatality rates (CFR) for AKI patients undergoing kidney replacement therapy (KRT) in Brazil is limited.
Purpose of the Study:
- To determine the CFR of critically ill COVID-19 patients receiving acute kidney replacement therapy (AKRT) in Brazil.
- To describe the characteristics and outcomes of these patients.
Main Methods:
- Retrospective descriptive cohort study of COVID-19 patients treated with AKRT.
- Included 100 patients from a single tertiary hospital over 15 months.
- Excluded patients under 18, those on chronic dialysis, and AKI preceding COVID-19.
Main Results:
- The overall CFR for COVID-19 patients on AKRT was 93%.
- Patients were older (median 74.5 years), frequently had hypertension (76%) and diabetes (56%).
- Most patients (85%) were on mechanical ventilation, and 87% of deaths occurred within 10 days of AKRT initiation.
Conclusions:
- Acute kidney replacement therapy for severe COVID-19 patients in Brazil is associated with a very high CFR.
- Older, critically ill patients with COVID-19 requiring AKRT have a poor prognosis.
- Urgent development of improved therapeutic strategies is necessary for this patient population.
Introduction:
Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT).
Methods:
Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection.
Results:
A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset.
Conclusion:
AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.
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