Among critically ill patients with COVID-19 complicated by acute kidney injury (AKI) requiring kidney replacement therapy (KRT), low baseline kidney function and reduced urine output at the time of KRT predicts a decreased likelihood of kidney recovery, according to study findings presented during Kidney Week 2021.
The Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) included 4221 patients with COVID-19 admitted to intensive care units at 68 US hospitals who were at risk for AKI. Of these, 876 experienced AKI requiring KRT. The group included 588 patients (67%) who died, 95 (11%) who survived to hospital discharge and remained dependent on KRT, and 193 (22%) who survived to hospital discharge without KRT dependence, Caroline M. Hsu, MD, of Tufts Medical Center in Boston, Massachusetts, and colleagues reported.
Compared with an estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) higher than 60, an eGFR of 15 or lower was significantly associated with 8.6-fold increased odds of not recovering kidney function, Dr Hsu and colleagues reported. With regard to the effect of urine output on kidney recovery, output of less than 50 mL per day on the day of KRT initiation was significantly associated with 4.2-fold increased odds of not recovering kidney function compared with output of more than 500 mL per day.
“We found that chronic kidney disease and low urine production at the time of dialysis initiation were associated with lower likelihood of recovery,” Dr Hsu said in an interview. “While these results are not surprising, they demonstrate a conceptual model in which recovery from acute kidney injury depends on both the pre-injury level of kidney function and the severity of the injury itself. These results may assist prognostication for long-term dialysis dependence, which carries long-term implications for patients’ physical health and quality of life.”
Led by Shruti Gupta, MD MPH, and David Leaf, MD MSSc, of Brigham and Women’s Hospital in Boston, Massachusetts, the STOP-COVID study involved more than 400 collaborators — including physicians, medical students, and study coordinators — who manually reviewed the charts of 5154 patients.
Hsu CM, Gupta S, Tighiouart H, et al. Recovery from AKI requiring kidney replacement therapy in critically ill patients with COVID-19. Presented at: Kidney Week 2021, November 2-7. Abstract PO0024.