Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States
Male
Kidney Disease
clinical trajectory
severe COVID-19
Comorbidity
Cardiovascular
Kidney Function Tests
intensive care unit
0302 clinical medicine
Risk Factors
end-stage kidney disease
Renal Insufficiency
Hospital Mortality
Chronic
Original Investigation
glomerular filtration rate
end-stage renal disease
Coronavirus disease 2019
Urology & Nephrology
3. Good health
Intensive Care Units
Treatment Outcome
Nephrology
6.1 Pharmaceuticals
Public Health and Health Services
Female
severe acute respiratory syndrome coronavirus 2
Critical Illness
Clinical Trials and Supportive Activities
clinical course
Clinical Sciences
Renal and urogenital
03 medical and health sciences
Clinical Research
Renal Dialysis
Humans
Renal Insufficiency, Chronic
STOP-COVID Investigators
COVID-19 outcome
Aged
Retrospective Studies
SARS-CoV-2
renal function
altered mental status
Evaluation of treatments and therapeutic interventions
COVID-19
United States
Good Health and Well Being
dialysis
prognosis
chronic kidney disease
in-hospital mortality
DOI:
10.1053/j.ajkd.2020.09.003
Publication Date:
2020-09-19T15:05:48Z
AUTHORS (318)
ABSTRACT
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.Retrospective cohort study.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.Presence (vs absence) of pre-existing kidney disease.In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary).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.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]).Potential residual confounding.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.
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