Provision of acute renal replacement therapy, using three separate modalities, in critically ill patients during the COVID-19 pandemic. An after action review from a UK tertiary critical care centre

Fisher, Richard; Clarke, Jonathan M.; Al-Arfi, Khaled; Saha, Rohit; Lioudaki, Eirini; Mehta, Reena; Pahl, Clemens; Sharpe, Claire C.; Bramham, Kate; Hutchings, Sam

doi:10.1016/j.jcrc.2020.12.023

Cited by 12 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 487 cases of AKI, 51% met KDIGO criteria for stage 1 ( n = 248), 13% ( n = 64) stage 2 and 36% ( n = 175) stage 3. A total of 109 patients (8.7% of total, 22% of all AKI) required RRT and the relevant modalities included CVVHDF, HD, PD or any combination of those (different modalities for a single patient were used at different times and according to clinical indication and resource availability) [ 15 ]. None of the patients required RRT following discharge from the hospital.…”

Section: Resultsmentioning

confidence: 99%

COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. Methods We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. Results Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. Conclusions This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

show abstract

Section: Resultsmentioning

confidence: 99%

COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Possible explanations are younger age and relatively low CCI and CFS. Other reasons may include factors [11,18,[41][42][43][44][45][46]. Our low dialysis dependence rates perhaps may be due to a relatively low proportion of patients with pre-existing CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Critical care bed capacity surged from 7.6 to 19.6 beds per 100,000 population [16]. The high prevalence of AKI and limited supply of consumables led to significant challenges and disruptions in KRT delivery [17,18].…”

mentioning

confidence: 99%

Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

Lumlertgul

Pirondini

Cooney

et al. 2021

Ann. Intensive Care

View full text Add to dashboard Cite

Background There are limited data on acute kidney injury (AKI) progression and long-term outcomes in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to describe the prevalence and risk factors for development of AKI, its subsequent clinical course and AKI progression, as well as renal recovery or dialysis dependence and survival in this group of patients. Methods This was a retrospective observational study in an expanded tertiary care intensive care unit in London, United Kingdom. Critically ill patients admitted to ICU between 1st March 2020 and 31st July 2020 with confirmed SARS-COV2 infection were included. Analysis of baseline characteristics, organ support, COVID-19 associated therapies and their association with mortality and outcomes at 90 days was performed. Results Of 313 patients (70% male, mean age 54.5 ± 13.9 years), 240 (76.7%) developed AKI within 14 days after ICU admission: 63 (20.1%) stage 1, 41 (13.1%) stage 2, 136 (43.5%) stage 3. 113 (36.1%) patients presented with AKI on ICU admission. Progression to AKI stage 2/3 occurred in 36%. Risk factors for AKI progression were mechanical ventilation [HR (hazard ratio) 4.11; 95% confidence interval (CI) 1.61–10.49] and positive fluid balance [HR 1.21 (95% CI 1.11–1.31)], while steroid therapy was associated with a reduction in AKI progression (HR 0.73 [95% CI 0.55–0.97]). Kidney replacement therapy (KRT) was initiated in 31.9%. AKI patients had a higher 90-day mortality than non-AKI patients (34% vs. 14%; p < 0.001). Dialysis dependence was 5% at hospital discharge and 4% at 90 days. Renal recovery was identified in 81.6% of survivors at discharge and in 90.9% at 90 days. At 3 months, 16% of all AKI survivors had chronic kidney disease (CKD); among those without renal recovery, the CKD incidence was 44%. Conclusions During the first COVID-19 wave, AKI was highly prevalent among severely ill COVID-19 patients with a third progressing to severe AKI requiring KRT. The risk of developing CKD was high. This study identifies factors modifying AKI progression, including a potentially protective effect of steroid therapy. Recognition of risk factors and monitoring of renal function post-discharge might help guide future practice and follow-up management strategies. Trial registration NCT04445259

show abstract

“…Although some of the studies conducted at the beginning of the pandemic showed that kidney involvement was not very common in patients with COVID-19, 16,17 we now know that kidney disease at admission and the development of AKI during 10 hospitalization are highly prevalent in patients with COVID-19 and are associated with in-hospital mortality. [31][32][33][34][35][36] Mortality rates of up to 70% have been reported among patients with COVID-19-related AKI. 37 The few studies of the topic in Brazil have reported mortality rates ranging from 72% to 93%.…”

Section: Discussionmentioning

confidence: 99%

Kidney Replacement Therapy in COVID-19-Related Acute Kidney Injury: the Importance of Timing

Almeida,

Oliveira,

Teixeira

et al. 2024

Preprint

View full text Add to dashboard Cite

The objective of this study was to evaluate two different criteria for deciding when KRT should be initiated in patients with COVID-19-related AKI, as well as to determine the impact of the timing of KRT, as defined by each criterion, on in-hospital mortality among such patients. This was a retrospective study involving 512 adult patients admitted to the ICU. All participants had laboratory-confirmed COVID-19 and a confirmed diagnosis of AKI. The potential predictors were the determination of the timing of KRT based on a temporal criterion (days since hospital admission) and that based on a serum creatinine cutoff criterion. Covariates included age, sex, and the SOFA score, as well as the need for mechanical ventilation and vasopressors. The main outcome measure was in-hospital mortality. We evaluated 512 patients, of whom 69.1% were men. The median age was 64 years. Of the 512 patients, 76.6% required dialysis after admission. The overall in-hospital mortality rate was 72.5%. When the timing of KRT was determined by the temporal criterion, the risk of in-hospital mortality was significantly higher for delayed KRT than for timely KRT, 84% higher in the univariate analysis (OR=1.84, 95%, [CI]: 1.10-3.09) and 140% higher after adjustment for age, sex, and SOFA score (OR=2.40, 95% CI: 1.36-4.24). When it was determined by the creatinine cutoff criterion, there was no such difference between high and low creatinine at KRT initiation. In patients with COVID-19-related AKI, earlier KRT appears to be associated with lower in-hospital mortality.

show abstract

Provision of acute renal replacement therapy, using three separate modalities, in critically ill patients during the COVID-19 pandemic. An after action review from a UK tertiary critical care centre

Cited by 12 publications

References 15 publications

COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

Kidney Replacement Therapy in COVID-19-Related Acute Kidney Injury: the Importance of Timing

Contact Info

Product

Resources

About