A Multicenter Observational Study of Clinical Features and Outcomes of AKI in Critically Ill Patients with COVID-19

Background: Acute kidney injury (AKI) is emerging as an important sequela of COVID-19 infection. Existing data on the incidence and clinical features of AKI in patients with COVID-19 are mainly limited to single-center studies. Given the high incidence of severe AKI among patients with COVID-19 and its strong association with mortality in other settings, we conducted a multicenter nationally representative cohort study to examine the incidence, clinical features, risk factors, and outcomes of AKI in critically ill patients with COVID-19. Methods: We used data from a multicenter observational study that collected granular, patient-level data from >3,000 critically ill adults with laboratory-confirmed COVID-19 admitted to participating ICUs from 67 centers across the United States. Using multivariable logistic regression, we examined risk factors for the primary composite outcome, AKI requiring renal replacement therapy or death (RRT/death) in the 14 days following ICU admission. Results: Among 3099 patients, 1205 (38.9%) developed the primary outcome of RRT/death (n=637 required RRT, n=792 died within 14 days, and n=224 both required RRT and died within 14 days). Independent risk factors for RRT/death included chronic kidney disease (odds ratio [OR], 5.02; 95% CI, 3.55-7.10 for eGFR<30 vs. ≥60; OR 1.90; 95% CI, 1.55-2.33 for eGFR 30-59 vs. ≥60), as well as older age, male sex, higher body mass index, and greater severity of hypoxemia on ICU admission (Figure). Patients admitted to hospitals with higher degrees of strain also had a greater risk of RRT/death (OR 1.49; 95% CI, 1.06-2.06 for highest versus lowest quintile of hospital strain).Figure 1Conclusions: This multicenter study identifies several key insights into the risk factors for RRT/death in critically ill patients with COVID-19. Funding: NIDDK Support, Other NIH Support - NIDCD F32DC017342