1. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States
- Author
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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, and Zhou, Yan
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Clinical Research ,Cardiovascular ,Clinical Trials and Supportive Activities ,Kidney Disease ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Renal and urogenital ,Good Health and Well Being ,Aged ,COVID-19 ,Comorbidity ,Critical Illness ,Female ,Hospital Mortality ,Humans ,Intensive Care Units ,Kidney Function Tests ,Male ,Renal Dialysis ,Renal Insufficiency ,Chronic ,Retrospective Studies ,Risk Factors ,SARS-CoV-2 ,Treatment Outcome ,United States ,STOP-COVID Investigators ,COVID-19 outcome ,Coronavirus disease 2019 ,altered mental status ,chronic kidney disease ,clinical course ,clinical trajectory ,critical illness ,dialysis ,end-stage kidney disease ,end-stage renal disease ,glomerular filtration rate ,in-hospital mortality ,intensive care unit ,prognosis ,renal function ,severe COVID-19 ,severe acute respiratory syndrome coronavirus 2 ,Clinical Sciences ,Public Health and Health Services ,Urology & Nephrology - 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.
- Published
- 2021