TY - JOUR
T1 - Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States
AU - STOP-COVID Investigators
AU - Flythe, Jennifer E.
AU - Assimon, Magdalene M.
AU - Tugman, Matthew J.
AU - Chang, Emily H.
AU - Gupta, Shruti
AU - Shah, Jatan
AU - Sosa, Marie Anne
AU - Renaghan, Amanda De Mauro
AU - Melamed, Michal L.
AU - Wilson, F. Perry
AU - Neyra, Javier A.
AU - Rashidi, Arash
AU - Boyle, Suzanne M.
AU - Anand, Shuchi
AU - Christov, Marta
AU - Thomas, Leslie F.
AU - Edmonston, Daniel
AU - Leaf, David E.
AU - Walther, Carl P.
AU - Anumudu, Samaya J.
AU - Arunthamakun, Justin
AU - Kopecky, Kathleen F.
AU - Milligan, Gregory P.
AU - McCullough, Peter A.
AU - Nguyen, Thuy Duyen
AU - Shaefi, Shahzad
AU - Krajewski, Megan L.
AU - Shankar, Sidharth
AU - Pannu, Ameeka
AU - Valencia, Juan D.
AU - Waikar, Sushrut S.
AU - Kibbelaar, Zoe A.
AU - Athavale, Ambarish M.
AU - Hart, Peter
AU - Upadhyay, Shristi
AU - Vohra, Ishaan
AU - Green, Adam
AU - Rachoin, Jean Sebastien
AU - Schorr, Christa A.
AU - Shea, Lisa
AU - Edmonston, Daniel L.
AU - Mosher, Christopher L.
AU - Shehata, Alexandre M.
AU - Sutherland, Anne K.
AU - Patrawalla, Amee
AU - Finkel, Diana G.
AU - Radbel, Jared
AU - Sunderram, Jag
AU - Scharf, Matthew T.
AU - Berim, Ilya
N1 - Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Rationale & Objective: Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. Study Design: Retrospective cohort study. Settings & Participants: 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States. Predictor(s): Presence (vs absence) of pre-existing kidney disease. Outcome(s): In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary). Analytical Approach: We used standardized differences to compare patient characteristics (values > 0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations. Results: Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference = 0.12) and those without pre-existing CKD (12%; standardized difference = 0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). Limitations: Potential residual confounding. Conclusions: Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.
AB - Rationale & Objective: Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. Study Design: Retrospective cohort study. Settings & Participants: 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States. Predictor(s): Presence (vs absence) of pre-existing kidney disease. Outcome(s): In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary). Analytical Approach: We used standardized differences to compare patient characteristics (values > 0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations. Results: Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference = 0.12) and those without pre-existing CKD (12%; standardized difference = 0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). Limitations: Potential residual confounding. Conclusions: Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.
KW - COVID-19 outcome
KW - Coronavirus disease 2019 (COVID-19)
KW - altered mental status
KW - chronic kidney disease (CKD)
KW - clinical course
KW - clinical trajectory
KW - critical illness
KW - dialysis
KW - end-stage kidney disease (ESKD)
KW - end-stage renal disease (ESRD)
KW - glomerular filtration rate (GFR)
KW - in-hospital mortality
KW - intensive care unit (ICU)
KW - prognosis
KW - renal function
KW - severe COVID-19
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
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U2 - 10.1053/j.ajkd.2020.09.003
DO - 10.1053/j.ajkd.2020.09.003
M3 - Article
C2 - 32961244
AN - SCOPUS:85096337886
SN - 0272-6386
VL - 77
SP - 190-203.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -