Association of antiplatelet and anticoagulation therapy with dialysis-requiring AKI in critically ill patients with COVID-19

ABSTRACT

Background: Critically ill patients with COVID-19 have a high incidence of thrombotic complications and dialysis-requiring acute kidney injury (AKI-D). COVID-19 hypercoagulability has been implicated as a possible contributor to AKI-D. Our hypothesis is that pre-existing antiplatelet (APT) or anticoagulation therapy (ACT) is associated with a lower incidence of AKI-D in critically ill patients with COVID-19. Methods: Records of patients with COVID-19 admitted to the ICU from March 13th -April 1st 2020 were reviewed. Exclusion criteria included ESRD status, and ICU discharge or death prior to 14 days of follow-up. Groups were divided based on APT or ACT prior to ICU admission. AKI-D was defined as initiation of renal replacement therapy (RRT) of any kind during the 14 days. Groups were compared using 2-tailed Fisher's exact test and unpaired t tests. Results: A total of 149 records were reviewed, and 98 patients were included (47 died and 4 discharged). Twenty-three patients (23.5%) were on APT or ACT and 39 (40%) required RRT. Table 1 compares characteristics by study group. Hypertension and cardiac conditions were significantly different between groups. Twelve (52%) of patients on APT or ACT required RRT and 27 (36%) not on either required RRT (p=0.22). Conclusions: Pre-existing APT or ACT was not associated with AKI-D in critically ill patients with COVID-19 and 2 weeks of follow up. Our study confirmed a high incidence of AKI-D but was limited by significant differences in cardiac conditions between study groups. Future larger studies examining this association in groups with comparable cardiac conditions are needed.