Kidney Week

Abstract: TH-PO1143

Short- and Long-Term Outcomes in Critically Ill Patients with COVID-19 and AKI

Session Information

• COVID-19
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Andrade, Juliana Alves Manhaes, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil

Juliana Alves Manhaes Andrade

• Meinerz, Gisele, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil

Gisele Meinerz, MD, PhD

• Rech, Eduardo Lange, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil

Eduardo Lange Rech, MD

• Palma, Raphael Hemann, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil

Raphael Hemann Palma, MD

• Dall Agnese, Marco Antônio Vinciprova, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil

Marco Antônio Vinciprova Dall Agnese

• Keitel, Elizete, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil

Elizete Keitel, MD, PhD

Background

Acute kidney injury (AKI) in the setting of COVID-19 infection is associated with worse outcomes. The aim of this study was to follow-up a sample of critically ill patients with COVID-19 and AKI analyzing AKI stages, kidney replacement therapy (KRT), and outcomes at 90 days and at 365 days after hospitalization.

Methods

Observational, prospective cohort study of hospitalized adults (> 18 years old) with severe COVID-19 admitted to the Intensive Care Units (ICUs) in a tertiary hospital in south of Brazil. Patients with nephrological assessment for AKI were included from May 1st, 2020, and April 30th, 2021. Outcomes within 3 months after the COVID-19 included death and kidney function recovery. Survived patients had the glomerular filtration estimated (eGFR) at baseline, discharge and at 12 months. Kaplan-Meier method was used to survivals and ANOVA to compare means. Risk factors for death was analyzed by Cox regression.

Results

360 patients were enrolled in the study, among them 60.6% were male, the mean age was 63.9 ± 12.5 years, 38.1% had diabetes, 68.6% had hypertension, 44.2% were obese, and 17.1% had ischemic cardiopathy. Median BMI was 29.0 (IQR 25.0-33.2). 98% required mechanical ventilation. AKI stage 1, 2 and 3 was detected in 3.6%, 5.6% and 90.8% of patients, respectively. KRT was indicated in 89.0% of patients. At 90 days follow-up, 317 (88.1%) of patients died before discharge, 7 (1.9%) remained on KRT, and 36 (10.0%) had kidney function recovered. Age (each 10 years increased risk 18%), requirement of KRT, and mechanical ventilation were associated with death within 90 days. Forty-three (43) patients (11.9% of the whole sample) survived beyond 90 days. Of those, 8 (18.6 %) patients died between 90 and 365 days and 5 (11.6 %) remained on KRT at 365 days. Thirty (30) patients (69.7%) were alive and free of KRT. The eGFR was not different between baseline (85.5 ± 23.6ml/min) and at discharge (81.7 ± 29.5ml/min). However, the mean eGFR at 365 days (65.9 ± 24.8ml/min) was lower (p=0.003).

Conclusion

Severe COVID-19 infected patients that developed AKI in ICU environment presented high mortality at 90 days (88,1%). Among survived patients 87% were free of dialysis. However, survivors at one year had a lower renal function compared to baseline.