Continuous renal replacement therapy in intensive care patients with COVID-19; survival and renal recovery

Abstract

Background Outcome for critically ill patients with COVID-19 treated with continuous renal replacement therapy (CRRT) is largely unknown. We describe mortality and renal outcome in this group. Methods This observational study was conducted at a university hospital in Sweden. We studied critically ill adult COVID-19 patients with Acute Kidney injury (AKI) who received CRRT. Results In 451 patients, AKI incidence was 43.7%. 18.2% received CRRT. Median age of CRRT patients was 60 years (IQR 54–65), 90% were male, median BMI was 29 (IQR 25–32), 23.2% had Diabetes, 37.8% hypertension and 6.1% chronic kidney disease prior to admission. 100% required mechanical ventilation. 8.5% received Extra Corporeal Membrane Oxygenation. Median length of stay was 23 days (IQR 15–26). ICU mortality was 39% and 90-day mortality was 45.1%. Age, baseline creatinine values and body weight change were associated with 60 days mortality. Of the survivors, no patients required dialysis at hospital discharge, 73.8% recovered renal function and a median 10.5% of body weight was lost during admission. Conclusions Critically ill COVID-19 patients with AKI who received CRRT had a 90-day mortality of 45.1%. At follow-up, three quarters of survivors had recovered renal function. This information is important in the clinical management of COVID-19.

Renal recovery after acute kidney injury in a minority population of hospitalized COVID-19 patients

“…[16] Similar findings were observed in a study from New York City (NYC) showing RR among 84% of AKI survivors. [16] In contrast, 32% of hospitalized COVID-19 patients with AKI in another NYC system had not recovered kidney function to their baseline at a median of 21 days after hospital discharge. [9] In NYC, the Bronx had the highest rate of hospitalizations and deaths due to COVID-19 per 100,000 population.…”

“…Good renal outcome after COVID-19 infection has been reported from Sweden, only 26.2% of patients had AKD on discharge and none of them required renal replacement therapy (RRT). [16] Similar findings were observed in a study from New York City (NYC) showing RR among 84% of AKI survivors. [16] In contrast, 32% of hospitalized COVID-19 patients with AKI in another NYC system had not recovered kidney function to their baseline at a median of 21 days after hospital discharge.…”

Outcomes Associated With Intensive Care and Organ Support Among Patients With COVID-19: A Systematic Review and Meta-Analysis

“…demonstrated a 90-day mortality of 45% and ICU mortality of 39% for a population of critically ill COVID-19 patients that required RRT. 33 All the patients in this study were treated with MV. In our series, mortality in patients requiring RRT approached 60%.…”

Experiences of Renal Replacement Therapy Delivery in Swedish Intensive Care Units during the COVID-19 Pandemic

“…Provision of RRT in Sweden seems in most cases to have met criteria for conventional care although in some instances where dose revision and machine rotation were necessary, care levels were reduced to the level of contingency care. Results from a study from our own unit demonstrated survival (57% at 3 months) and renal recovery, defined as return to within 1.5 times baseline creatinine (occurring in 73.8%) among COVID-19 RRT patients to be relatively high compared to data from other countries and would suggest that care levels were maintained at an adequate level [ 20 ].…”

“…The study highlights the importance of the flexible use of different renal replacement modalities during a crisis and the importance of collaboration with nephrological services. The survey showed that IHD was administered to a majority of patients at some point during their ICU stay, and in a study of COVID-19 ICU patients at Stockholm's Karolinska hospital, 40% of ICU survivors received at least one IHD treatment after ICU discharge [ 20 ].…”