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. 2020 Dec 28;15(12):e0244131.
doi: 10.1371/journal.pone.0244131. eCollection 2020.

High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Jacob S Stevens  1   2   3 , Kristen L King  1   2 , Shelief Y Robbins-Juarez  3 , Pascale Khairallah  1 , Katherine Toma  1 , Hector Alvarado Verduzco  1 , Emily Daniel  1 , Denzil Douglas  1 , Andrew A Moses  1 , Yonatan Peleg  1 , Piotr Starakiewicz  1 , Miah T Li  1   2 , Daniel W Kim  1   2 , Kathleen Yu  2   3 , Long Qian  2   3 , Vaqar H Shah  1 , Max R O'Donnell  4   5 , Matthew J Cummings  4 , Jason Zucker  6 , Karthik Natarajan  7 , Adler Perotte  7 , Demetra Tsapepas  8   9 , Kiryluk Krzysztof  1   3 , Geoffrey Dube  1   3 , Eric Siddall  1   3 , Shayan Shirazian  1   3 , Thomas L Nickolas  1   3 , Maya K Rao  1   3 , Jonathan M Barasch  1   3 , Anthony M Valeri  1   3 , Jai Radhakrishnan  1   2   3 , Ali G Gharavi  1   3 , S Ali Husain  1   2   3 , Sumit Mohan  1   2   3
Affiliations

High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Jacob S Stevens et al. PLoS One. .

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.

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Conflict of interest statement

The authors declare that they have no financial conflicts of interest to disclose. MRO and MJC are both investigators for Remdesivir (sponsored by Gilead) and convalescent plasma (sponsored by Amazon). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Outcomes of patients receiving renal replacement therapy for acute kidney injury.
(A) Relative composition of the cohort showing the proportion of patients who have died (gray), recovered (bright blue), remained on renal replacement therapy (dark blue) or reached the end of follow-up over time (yellow). (B) Cumulative incidence plots of time to initiation of renal replacement therapy from: Symptom onset (red), hospital admission (blue), intubation (yellow) and ICU admission (black).
Fig 2
Fig 2. Patient survival curves.
(A) Kaplan Meier curve for patient survival over time from the time of initiation of renal replacement therapy for all patients and (B) stratified by tertiles of SOFA scores.
See this image and copyright information in PMC

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