AUTHOR=Braunsteiner Josephine , Jarczak Dominik , Schmidt-Lauber Christian , Boenisch Olaf , de Heer Geraldine , Burdelski Christoph , Frings Daniel , Sensen Barbara , Nierhaus Axel , Hoxha Elion , Huber Tobias B. , Wichmann Dominic , Kluge Stefan , Fischer Marlene , Roedl Kevin 

TITLE=Outcomes of critically ill coronavirus disease 2019 patients requiring kidney replacement therapy: A retrospective cohort study

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1027586

DOI=10.3389/fmed.2022.1027586

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>Coronavirus disease 2019 (COVID-19) has resulted in high hospitalization rates worldwide. Acute kidney injury (AKI) in patients hospitalized for COVID-19 is frequent and associated with disease severity and poor outcome. The aim of this study was to investigate the incidence of kidney replacement therapy (KRT) in critically ill patients with COVID-19 and its implication on outcome.</p></sec><sec><title>Methods</title><p>We retrospectively analyzed all COVID-19 patients admitted to the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf (Germany) between 1 March 2020 and 31 July 2021. Demographics, clinical parameters, type of organ support, length of intensive care unit (ICU) stay, mortality and severity scores were assessed.</p></sec><sec><title>Results</title><p>Three-hundred critically ill patients with COVID-19 were included. The median age of the study population was 61 (IQR 51–71) years and 66% (<italic>n</italic> = 198) were male. 73% (<italic>n</italic> = 219) of patients required invasive mechanical ventilation. Overall, 68% (<italic>n</italic> = 204) of patients suffered from acute respiratory distress syndrome and 30% (<italic>n</italic> = 91) required extracorporeal membrane oxygenation (ECMO). We found that 46% (<italic>n</italic> = 139) of patients required KRT. Septic shock (OR 11.818, 95% CI: 5.941–23.506, <italic>p</italic> &lt; 0.001), higher simplified acute physiology scores (SAPS II) (OR 1.048, 95% CI: 1.014–1.084, <italic>p</italic> = 0.006) and vasopressor therapy (OR 5.475, 95% CI: 1.127–26.589, <italic>p</italic> = 0.035) were independently associated with the initiation of KRT. 61% (<italic>n</italic> = 85) of patients with and 18% (<italic>n</italic> = 29) without KRT died in the ICU (<italic>p</italic> &lt; 0.001). Cox regression found that KRT was independently associated with mortality (HR 2.075, 95% CI: 1.342–3.208, <italic>p</italic> = 0.001) after adjusting for confounders.</p></sec><sec><title>Conclusion</title><p>Critically ill patients with COVID-19 are at high risk of acute kidney injury with about half of patients requiring KRT. The initiation of KRT was associated with high mortality.</p></sec>