Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States

被引:166
作者
Flythe, Jennifer E. [1 ,2 ]
Assimon, Magdalene M. [1 ]
Tugman, Matthew J. [1 ]
Chang, Emily H. [1 ]
Gupta, Shruti [3 ]
Shah, Jatan [4 ]
Sosa, Marie Anne [5 ,6 ]
Renaghan, Amanda DeMauro [7 ]
Melamed, Michal L. [8 ]
Wilson, F. Perry [9 ,10 ]
Neyra, Javier A. [11 ]
Rashidi, Arash [12 ]
Boyle, Suzanne M. [13 ]
Anand, Shuchi [14 ]
Christov, Marta [15 ]
Thomas, Leslie F. [16 ]
Edmonston, Daniel [17 ,18 ,19 ]
Leaf, David E. [3 ]
机构
[1] Univ N Carolina, Dept Med, Div Nephrol & Hypertens, Kidney Ctr,UNC Sch Med, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27599 USA
[3] Brigham & Womens Hosp, Dept Med, Div Renal Med, 75 Francis St, Boston, MA 02115 USA
[4] Med Coll Wisconsin, Dept Med, Div Pulm Crit Care & Sleep Med, Milwaukee, WI 53226 USA
[5] Univ Miami, Miller Sch Med, Div Nephrol, Dept Med, Miami, FL 33136 USA
[6] Jackson Mem Hosp, Miami, FL 33136 USA
[7] Univ Virginia Hlth Syst, Charlottesville, VA USA
[8] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med Nephrol, Bronx, NY 10467 USA
[9] Yale Univ, Sch Med, Dept Med, Sect Nephrol, New Haven, CT 06510 USA
[10] Yale Univ, Sch Med, Clin & Translat Res Accelerator, New Haven, CT USA
[11] Univ Kentucky, Dept Internal Med, Div Nephrol Bone & Mineral Metab, Lexington, KY USA
[12] Univ Hosp Cleveland, Dept Med, Med Ctr, Div Nephrol & Hypertens, Cleveland, OH USA
[13] Temple Univ, Dept Med, Sect Nephrol Hypertens & Kidney Transplantat, Lewis Katz Sch Med, Philadelphia, PA USA
[14] Stanford Univ, Sch Med, Dept Med, Div Nephrol, Palo Alto, CA 94304 USA
[15] Westchester Med Ctr, Dept Med, Div Nephrol, Valhalla, NY USA
[16] Mayo Clin Arizona, Div Nephrol & Hypertens, Dept Internal Med, Scottsdale, AZ USA
[17] Duke Univ, Sch Med, Dept Med, Div Nephrol, Durham, NC 27706 USA
[18] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC 27706 USA
[19] Durham VA Med Ctr, Renal Sect, Durham, NC USA
基金
美国国家卫生研究院;
关键词
NEW-YORK-CITY; EXPRESSION; INFECTION; MONOCYTES; EQUATION; ADULTS; RATES;
D O I
10.1053/j.ajkd.2020.09.003
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Rationale & Objective: Underlying 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 preexisting chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and inhospital outcomes. Study Design: Retrospective cohort study. Settings & Participants: 4,264 critically ill patients with COVID-19 (143 patients with preexisting kidney failure receiving maintenance dialysis; 521 patients with pre-existing nondialysis-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 preexisting 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 Approach: We 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. Results: Dialysis 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 inhospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysisdependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). Limitations: Potential residual confounding. Conclusions: Findings 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.
引用
收藏
页码:190 / +
页数:15
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