Outcomes in COVID-19-Related AKI Requiring RRT

NKF Spring Clinical Meetings 2021

Acute kidney injury (AKI) incidence among patients with COVID-19 has been reported as high as 47%, and mortality ranges from 35% to 80% in patients with COVID-19-related AKI. The risk of mortality is increased in patients with COVID-19-related AKI requiring renal replacement therapy (RRT). Kevin Kin, DO, and colleagues conducted a study to describe outcomes among hospitalized patients with COVID-19-related AKI requiring RRT from a large diverse population in Southern California.

Results of the retrospective cohort study were reported during a virtual poster session at NKF Spring Clinical Meetings 2021. The poster was titled Outcomes of Hospitalized Patients with COVID-19 and Acute Kidney Injury Requiring Renal Replacement Therapy.

The study included patients with COVID-19-related AKI requiring RRT (defined as conventional  hemodialysis, continuous RRT, or both) within the Kaiser Permanente Southern California health system from March 14, 2020, through September 30, 2020. The researchers collected data on patient characteristics, comorbidities, laboratory values, modality of RRT, mortality, and RRT requirements following hospital discharge.

The cohort included 167 patients with COVID-19-related AKI requiring RRT. Median age of the cohort was 62 years. Overall, 114 (68) patients died during the hospitalization, with a median of 8 days in RRT (range, 1-83 days). Fifty-six patients (49.1%) died within 7 days of RRT initiation, 87 (76.3%) within 14 days of RRT initiation, and 106 (93.0%) within 30 days of RRT initiation. The highest mortality rates were seen among patients with COVID-19-related AKI requiring RRT with baseline estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m² compared with 64% and 39% among patients with eGFR 30-59 mL/min/1.73 m² and <30 mL/min/1.73 m², respectively.

Among the patients who survived and no longer required RRT, mean number of RRT days was 21. Twenty-nine of the 53 patients (54.7%) who were discharged from the hospital continued to require RRT on an outpatient basis.

In conclusion, the researchers said, “Among COVID-19 patients hospitalized with AKI requiring RRT, patient survival was low (32%). For patients who survived, more than half continued to be dialysis dependent. Given our findings and as COVID treatment continues to evolve, we hope to elucidate additional factors that may impact AKI and survival in COVID-19 patients.”

Source: Kin K, Gysi M, Lu D, Selevan D, Sim J. Outcomes of hospitalized patients with COVID-19 and acute kidney injury requiring renal replacement therapy. Abstract of a poster presented at the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Abstract #14), April 9, 2021.