Acute kidney injury (AKI) requiring dialysis among hospitalized patients with COVID-19 is associated with a high mortality rate, investigators reported at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

Upon hospital discharge, more than half of patients who survived continued to require dialysis on an outpatient basis, a team led by Kevin C. Kin, DO, of Kaiser Permanente Los Angeles Medical Center in California, reported in a poster presentation.

“During COVID surges over the past year, nephrologists were burdened with triaging and allocating renal replacement therapy resources, including at times needing to limit dialysis prescriptions,” Dr Kin told Renal & Urology News. “Understanding characteristics and outcomes among these critically ill patients may help guide management.”

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In a retrospective cohort study that included 167 patients hospitalized with COVID-19 during March 14, 2020 and September 20, 2020 who had AKI requiring dialysis, Dr Kin and colleagues found that 114 (68%) died during the hospitalization. Of these, 56 (49.1%) died within 7 days of initiating RRT, 87 (76.3%) within 14 days, and 106 (93%) within 30 days.

Of 53 surviving patients, 29 (54.7%) required outpatient dialysis at hospital discharge.

The investigators observed the highest mortality rate (75.2%) among patients without preexisting chronic kidney disease (CKD) — those who had an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or higher. By comparison, the rate was 64% and 39% for those with an eGFR of 30-59 and 29 mL/min/1.73 m2 or less, respectively.

“This suggests that those without CKD likely had more severe illness, and dialysis may not have impacted mortality from COVID,” Dr Kin explained, adding that long-term complications in these patients may include dialysis dependency or increased risk for end-stage kidney disease.


Kin KC, Gysi M, Lu D, Selevan DC, Sim JJ. Outcomes of hospitalized patients with COVID-19 and acute kidney injury requiring renal replacement therapy. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10. Poster 14.