Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.
Am J Kidney Dis
; 77(2): 190-203.e1, 2021 02.
Article
en En
| MEDLINE
| ID: mdl-32961244
ABSTRACT
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. STUDYDESIGN:
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). ANALYTICALAPPROACH:
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.Palabras clave
COVID-19 outcome; Coronavirus disease 2019 (COVID-19); altered mental status; chronic kidney disease (CKD); clinical course; clinical trajectory; critical illness; dialysis; end-stage kidney disease (ESKD); end-stage renal disease (ESRD); glomerular filtration rate (GFR); in-hospital mortality; intensive care unit (ICU); prognosis; renal function; severe COVID-19; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
4_TD
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6_ODS3_enfermedades_notrasmisibles
Problema de salud:
4_pneumonia
/
6_chronic_kidney_disease
/
6_kidney_renal_pelvis_ureter_cancer
/
6_other_respiratory_diseases
Asunto principal:
Enfermedad Crítica
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Insuficiencia Renal Crónica
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COVID-19
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Unidades de Cuidados Intensivos
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am J Kidney Dis
Año:
2021
Tipo del documento:
Article