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Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.
Flythe, Jennifer E; Assimon, Magdalene M; Tugman, Matthew J; Chang, Emily H; Gupta, Shruti; Shah, Jatan; Sosa, Marie Anne; Renaghan, Amanda DeMauro; Melamed, Michal L; Wilson, F Perry; Neyra, Javier A; Rashidi, Arash; Boyle, Suzanne M; Anand, Shuchi; Christov, Marta; Thomas, Leslie F; Edmonston, Daniel; Leaf, David E.
  • Flythe JE; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC. Electronic address: jflythe@med.unc.edu.
  • Assimon MM; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC.
  • Tugman MJ; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC.
  • Chang EH; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC.
  • Gupta S; Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
  • Shah J; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
  • Sosa MA; Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL.
  • Renaghan AD; Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, VA.
  • Melamed ML; Department of Medicine/Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
  • Wilson FP; Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT.
  • Neyra JA; Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington, KY.
  • Rashidi A; Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
  • Boyle SM; Section of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
  • Anand S; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
  • Christov M; Division of Nephrology, Department of Medicine, Westchester Medical Center, Valhalla, NY.
  • Thomas LF; Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic in Arizona, Scottsdale, AZ.
  • Edmonston D; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Renal Section, Durham VA Medical Center, Durham, NC.
  • Leaf DE; Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Am J Kidney Dis ; 77(2): 190-203.e1, 2021 02.
Article in English | MEDLINE | ID: covidwho-780044
Semantic information from SemMedBD (by NLM)
1. Persons USES Preexisting Condition Coverage
Subject
Persons
Predicate
USES
Object
Preexisting Condition Coverage
2. Kidney Diseases PREDISPOSES Much worse
Subject
Kidney Diseases
Predicate
PREDISPOSES
Object
Much worse
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. Chronic Kidney Diseases PROCESS_OF Patients
Subject
Chronic Kidney Diseases
Predicate
PROCESS_OF
Object
Patients
5. Intermediate Risk PROCESS_OF Patients
Subject
Intermediate Risk
Predicate
PROCESS_OF
Object
Patients
6. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Patients
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Patients
7. Therapeutic procedure TREATS Vulnerable Populations
Subject
Therapeutic procedure
Predicate
TREATS
Object
Vulnerable Populations
8. Persons USES Preexisting Condition Coverage
Subject
Persons
Predicate
USES
Object
Preexisting Condition Coverage
9. Kidney Diseases PREDISPOSES Much worse
Subject
Kidney Diseases
Predicate
PREDISPOSES
Object
Much worse
10. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
11. Chronic Kidney Diseases PROCESS_OF Patients
Subject
Chronic Kidney Diseases
Predicate
PROCESS_OF
Object
Patients
12. Intermediate Risk PROCESS_OF Patients
Subject
Intermediate Risk
Predicate
PROCESS_OF
Object
Patients
13. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Patients
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
PROCESS_OF
Object
Patients
14. Therapeutic procedure TREATS Vulnerable Populations
Subject
Therapeutic procedure
Predicate
TREATS
Object
Vulnerable Populations
ABSTRACT
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 pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. STUDY

DESIGN:

Retrospective cohort study. SETTINGS &

PARTICIPANTS:

4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-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 pre-existing 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 in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent 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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Critical Illness / Renal Insufficiency, Chronic / COVID-19 / Intensive Care Units Subject: Critical Illness / Renal Insufficiency, Chronic / COVID-19 / Intensive Care Units Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Am J Kidney Dis Clinical aspect: Etiology / Prediction / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Critical Illness / Renal Insufficiency, Chronic / COVID-19 / Intensive Care Units Subject: Critical Illness / Renal Insufficiency, Chronic / COVID-19 / Intensive Care Units Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Am J Kidney Dis Clinical aspect: Etiology / Prediction / Prognosis Year: 2021
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