ABSTRACT
The incidence of acute kidney injury (AKI) in COVID-19 patients has been reported as high as 47%, with mortality ranging from 3580% in this population. AKI patients requiring renal replacement therapy (RRT) likely have a greater mortality risk. Our aim was to describe outcomes of AKI patients who required RRT among hospitalized COVID-19 patients from a large diverse population in Southern California. We conducted a retrospective cohort study of COVID-19 patients with AKI requiring RRT defined as conventional hemodialysis, continuous renal replacement therapy, or both, within Kaiser Permanente Southern California in the period of 3/14/2020 through 9/30/2020. We collected information on patient characteristics, comorbidities, laboratory values, RRT modality, mortality, and post hospitalization RRT requirements. A total of 167 COVID-19 patients, median age 62 years (range 2592), had AKI requiring RRT. Overall, 114 (68%) patients died during the hospitalization, with a median of 8 days on RRT (range 1-83). Fifty-six (49.1%) patients expired within 7 days of initiating RRT, 87 (76.3%) within 14 days, and 106 (93.0%) within 30 days. Highest mortality rates were observed among AKI RRT patients with baseline eGFR >60 (75.2%), compared to 64% and 39% among patients with eGFR 30-59 and <30 ml/min respectively. Among patients who survived and no longer required dialysis, the mean number of inpatient RRT days was 21 (SD 16). Upon discharge from the hospital 29/53 (54.7%) patients continued to require RRT on an outpatient basis. Among COVID-19 patients hospitalized with AKI requiring RRT, patient survival was low (32%). For patients who survived, more than half continued to be dialysis dependent. Given our findings and as COVID treatment continues to evolve, we hope to elucidate additional factors that may impact AKI and survival in COVID-19 patients.