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 - Cohen, Zaza
AU - Allusson, Valerie
AU - Bambrick-Santoyo, Gabriela
AU - Bhatti, Noor ul aain
AU - Mehta, Bijal
AU - Williams, Aquino
AU - Albertson, Timothy E.
N1 - Funding Information:
Drs Flythe and Assimon are supported by R01 HL152034 from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Dr Flythe is supported by K23 DK109401 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH . Dr Wilson is supported by R01DK113191 and P30DK097310 from the NIDDK of the NIH . Dr Anand is supported by K23 DK101826 from the NIDDK of the NIH . Dr Christov is supported by the Westchester Community Foundation – Renal Clinic Fund. Dr Leaf is supported by R01DK125786 from the NIDDK of the NIH and R01HL144566 from the NHLBI of the NIH . The funders played no role in study design; data collection, analysis, or reporting; or the decision to submit for publication.
PY - 2020
Y1 - 2020
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 - altered mental status
KW - chronic kidney disease (CKD)
KW - clinical course
KW - clinical trajectory
KW - Coronavirus disease 2019 (COVID-19)
KW - COVID-19 outcome
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 acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
KW - severe COVID-19
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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
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
ER -