AUTHOR=Braunsteiner Josephine , Jarczak Dominik , Schmidt-Lauber Christian , Boenisch Olaf , de Heer Geraldine , Burdelski Christoph , Frings Daniel , Sensen Barbara , Nierhaus Axel , Hoxha Elion , Huber Tobias B. , Wichmann Dominic , Kluge Stefan , Fischer Marlene , Roedl Kevin 

TITLE=Outcomes of critically ill coronavirus disease 2019 patients requiring kidney replacement therapy: A retrospective cohort study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1027586

DOI=10.3389/fmed.2022.1027586

ISSN=2296-858X

ABSTRACT=Background: COVID-19 has resulted in high hospitalization rates worldwide. Acute kidney injury (AKI) in patients hospitalized for COVID-19 is frequent and associated with disease severity and poor outcome. The aim of this study was to investigate the incidence of kidney replacement therapy (KRT) in critically ill patients with COVID-19 and its implication on outcome. 
Methods: We retrospectively analyzed all COVID-19 patients admitted to the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf (Germany) between March 1st, 2020 and July 31st, 2021. Demographics, clinical parameters, type of organ support, length of ICU stay, mortality and severity scores were assessed.  
Results: Three-hundred critically ill patients with COVID-19 were included. The median age of the study population was 61 (IQR 51 – 71) years and 66% (n = 198) were male. 73% (n = 219) of patients required invasive mechanical ventilation. Overall, 68% (n = 204) of patients suffered from acute respiratory distress syndrome and 30% (n = 91) required extracorporeal membrane oxygenation (ECMO). We found that 46% (n = 139) of patients required KRT. Septic shock [OR 11.818, 95% CI 5.941 – 23.506, p < 0.001], higher Simplified Acute Physiology Scores (SAPS II) [OR 1.048, 95% CI 1.014 – 1.084, p = 0.006] and vasopressor therapy [OR 5.475, 95% CI 1.127 – 26.589, p = 0.035] were independently associated with the initiation of KRT. 61% (n = 85) of patients with and 18% (n = 29) without KRT died in the ICU (p < 0.001). Cox regression found that KRT was independently associated with mortality [HR 2.075, 95% CI 1.342 – 3.208, p = 0.001] after adjusting for confounders. 
Conclusion: Critically ill patients with COVID-19 are at high risk of kidney injury with about half of patients requiring KRT. The initiation of KRT was associated with high mortality.