학술논문
Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States
Document Type
article
Author
Flythe, Jennifer E; Assimon, Magdalene M; Tugman, Matthew J; Chang, Emily H; Gupta, Shruti; Shah, Jatan; Sosa, Marie Anne; Renaghan, Amanda DeMauro; Melamed, Michal L; Wilson, F Perry; Neyra, Javier A; Rashidi, Arash; Boyle, Suzanne M; Anand, Shuchi; Christov, Marta; Thomas, Leslie F; Edmonston, Daniel; Leaf, David E; Walther, Carl P; Anumudu, Samaya J; Arunthamakun, Justin; Kopecky, Kathleen F; Milligan, Gregory P; McCullough, Peter A; Nguyen, Thuy-Duyen; Shaefi, Shahzad; Krajewski, Megan L; Shankar, Sidharth; Pannu, Ameeka; Valencia, Juan D; Waikar, Sushrut S; Kibbelaar, Zoe A; Athavale, Ambarish M; Hart, Peter; Upadhyay, Shristi; Vohra, Ishaan; Green, Adam; Rachoin, Jean-Sebastien; Schorr, Christa A; Shea, Lisa; Edmonston, Daniel L; Mosher, Christopher L; Shehata, Alexandre M; Cohen, Zaza; Allusson, Valerie; Bambrick-Santoyo, Gabriela; Bhatti, Noor ul aain; Mehta, Bijal; Williams, Aquino; Brenner, Samantha K; Walters, Patricia; Go, Ronaldo C; Rose, Keith M; Chan, Lili; Mathews, Kusum S; Coca, Steven G; Altman, Deena R; Saha, Aparna; Soh, Howard; Wen, Huei Hsun; Bose, Sonali; Leven, Emily A; Wang, Jing G; Mosoyan, Gohar; Nadkarni, Girish N; Pattharanitima, Pattharawin; Gallagher, Emily J; Friedman, Allon N; Guirguis, John; Kapoor, Rajat; Meshberger, Christopher; Kelly, Katherine J; Parikh, Chirag R; Garibaldi, Brian T; Corona-Villalobos, Celia P; Wen, Yumeng; Menez, Steven; Malik, Rubab F; Cervantes, Carmen Elena; Gautam, Samir C; Mallappallil, Mary C; Ouyang, Jie; John, Sabu; Yap, Ernie; Melaku, Yohannes; Mohamed, Ibrahim; Bajracharya, Siddhartha; Puri, Isha; Thaxton, Mariah; Bhattacharya, Jyotsna; Wagner, John; Boudourakis, Leon; Nguyen, H Bryant; Ahoubim, Afshin; Kashani, Kianoush; Tehranian, Shahrzad; Sirganagari, Dheeraj Reddy; Guru, Pramod K; Zhou, Yan
Source
American Journal of Kidney Diseases. 77(2)
Subject
Language
Abstract
Rationale & objectiveUnderlying 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 designRetrospective cohort study.Settings & participants4,264 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 approachWe 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.ResultsDialysis 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]).LimitationsPotential residual confounding.ConclusionsFindings 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.