Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Perm J. 2022 Sep 14;26(3):39-45. doi: 10.7812/TPP/21.197. Epub 2022 Aug 15.
IntroductionAcute kidney injury (AKI) occurs in up to 10%-30% of coronavirus disease 2019 (COVID-19) patients. AKI patients who require renal replacement therapy (RRT) often have concurrent respiratory failure and represent a high-mortality-risk population. The authors sought to describe outcomes in hospitalized COVID-19 patients with AKI requiring RRT and determine factors associated with poor outcomes. MethodsA retrospective cohort study of hospitalized COVID-19 patients with AKI requiring RRT during the period from March 14, 2020, to September 30, 2020, was performed at Kaiser Permanente Southern California. RRT was defined as conventional hemodialysis and/or continuous renal replacement therapy. The primary outcome was hospitalization mortality, and secondary outcomes were mechanical ventilation, vasopressor support, and dialysis dependence among discharged patients. Hospitalization mortality risk ratios were estimated up to 30 days from RRT initiation. ResultsA total of 167 hospitalized COVID-19 patients were identified with AKI requiring RRT. The study population had a mean age of 60.7 years and included 71.3% male patients and 60.5% Hispanic patients. Overall, 114 (68.3%) patients died during their hospitalization. Among patients with baseline estimated glomerular filtration rate (eGFR) values of ≥ 60, 30-59, and < 30 mL/min, the mortality rates were 76.8%, 78.1%, and 50.0%, respectively. Among the 53 patients who survived to hospital discharge, 29 (54.7%) continued to require RRT. Compared to patients with eGFR < 30 mL/min, the adjusted 30-day hospitalization mortality risk ratios (95% CI) were 1.38 (0.90-2.12) and 1.54 (1.06-2.25) for eGFR values of 30-59 and ≥ 60, respectively. ConclusionAmong a diverse cohort of hospitalized COVID-19 patients with AKI requiring RRT, survival to discharge was low. Greater mortality was observed among patients with higher baseline kidney function. Most of the patients discharged alive continued to be dialysis-dependent.
介绍
急性肾损伤（AKI）在多达 10%-30%的 2019 年冠状病毒病（COVID-19）患者中发生。需要肾脏替代治疗（RRT）的 AKI 患者通常同时患有呼吸衰竭，代表着高死亡率的人群。作者旨在描述需要 RRT 的 COVID-19 合并 AKI 住院患者的结局，并确定与不良结局相关的因素。
方法
这是一项在 2020 年 3 月 14 日至 9 月 30 日期间在 Kaiser Permanente Southern California 进行的回顾性队列研究，研究对象为需要 RRT 的 COVID-19 合并 AKI 住院患者。RRT 的定义为常规血液透析和/或连续肾脏替代治疗。主要结局是住院死亡率，次要结局是出院患者的机械通气、血管加压素支持和透析依赖。从 RRT 开始计算，住院死亡率风险比最高可达 30 天。
结果
共确定了 167 名需要 RRT 的 COVID-19 合并 AKI 住院患者。研究人群的平均年龄为 60.7 岁，包括 71.3%的男性患者和 60.5%的西班牙裔患者。总体而言，114（68.3%）名患者在住院期间死亡。在基线估算肾小球滤过率（eGFR）值≥60、30-59 和<30 mL/min 的患者中，死亡率分别为 76.8%、78.1%和 50.0%。在 53 名存活至出院的患者中，29 名（54.7%）继续需要 RRT。与 eGFR<30 mL/min 的患者相比，eGFR 值为 30-59 和≥60 的患者的 30 天住院死亡率风险比（95%CI）分别为 1.38（0.90-2.12）和 1.54（1.06-2.25）。
结论
在需要 RRT 的 COVID-19 合并 AKI 住院患者的多样化队列中，存活至出院的患者比例较低。基线肾功能较高的患者死亡率更高。大多数存活出院的患者仍依赖透析。
