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High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy.
Stevens, Jacob S; King, Kristen L; Robbins-Juarez, Shelief Y; Khairallah, Pascale; Toma, Katherine; Alvarado Verduzco, Hector; Daniel, Emily; Douglas, Denzil; Moses, Andrew A; Peleg, Yonatan; Starakiewicz, Piotr; Li, Miah T; Kim, Daniel W; Yu, Kathleen; Qian, Long; Shah, Vaqar H; O'Donnell, Max R; Cummings, Matthew J; Zucker, Jason; Natarajan, Karthik; Perotte, Adler; Tsapepas, Demetra; Krzysztof, Kiryluk; Dube, Geoffrey; Siddall, Eric; Shirazian, Shayan; Nickolas, Thomas L; Rao, Maya K; Barasch, Jonathan M; Valeri, Anthony M; Radhakrishnan, Jai; Gharavi, Ali G; Husain, S Ali; Mohan, Sumit.
  • Stevens JS; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • King KL; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • Robbins-Juarez SY; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
  • Khairallah P; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Toma K; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • Alvarado Verduzco H; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
  • Daniel E; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Douglas D; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Moses AA; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Peleg Y; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Starakiewicz P; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Li MT; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Kim DW; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Yu K; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Qian L; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Shah VH; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • O'Donnell MR; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Cummings MJ; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • Zucker J; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • Natarajan K; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
  • Perotte A; Columbia University Renal Epidemiology Group, New York, NY, United States of America.
  • Tsapepas D; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
  • Krzysztof K; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Dube G; Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Siddall E; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
  • Shirazian S; Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Nickolas TL; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Rao MK; Department of Biomedical Informatics, Columbia University, New York, NY, United States of America.
  • Barasch JM; Department of Biomedical Informatics, Columbia University, New York, NY, United States of America.
  • Valeri AM; Department of Pharmacy, New-York Presbyterian Hospital, New York, NY, United States of America.
  • Radhakrishnan J; Department of Quality, New-York Presbyterian Hospital, New York, NY, United States of America.
  • Gharavi AG; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
  • Husain SA; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
  • Mohan S; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
PLoS One ; 15(12): e0244131, 2020.
Article in English | MEDLINE | ID: covidwho-999832
ABSTRACT

INTRODUCTION:

A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course.

METHODS:

We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses.

RESULTS:

Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days 0.46 [95% CI 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 / Kidney Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0244131

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 / Kidney Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0244131