High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Stevens, Jacob S.; King, Kristen L.; Robbins-Juarez, Shelief Y.; Khairallah, Pascale; Toma, Katherine; Alvarado Verduzco, Hector; Daniel, Emily; Douglas, Denzil; Moses, Andrew A.; Peleg, Yonatan; Starakiewicz, Piotr; Li, Miah T.; Kim, Daniel W.; Yu, Kathleen; Qian, Long; Shah, Vaqar H.; O'Donnell, Max R.; Cummings, Matthew J.; Zucker, Jason; Natarajan, Karthik; Perotte, Adler; Tsapepas, Demetra; Krzysztof, Kiryluk; Dube, Geoffrey; Siddall, Eric; Shirazian, Shayan; Nickolas, Thomas L.; Rao, Maya K.; Barasch, Jonathan M.; Valeri, Anthony M.; Radhakrishnan, Jai; Gharavi, Ali G.; Husain, S. Ali; Mohan, Sumit

INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36–0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46–10.90] and 3.10 [95% CI 1.25–7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21–4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65–7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.