PLoS ONE (Jan 2022)

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

  • Farid Samaan,
  • Elisa Carneiro de Paula,
  • Fabrizzio Batista Guimarães de Lima Souza,
  • Luiz Fernando Cardoso Mendes,
  • Paula Regina Gan Rossi,
  • Rafaela Andrade Penalva Freitas,
  • Fernando Takahashi Nakagawa,
  • Alexandre Toledo Maciel,
  • Sylvia Aranha,
  • Eduardo Osawa,
  • Henrique Pinheiro Konigsfeld,
  • Riberto Garcia da Silva,
  • Ricardo Barbosa Cintra de Souza,
  • Saurus Mayer Coutinho,
  • Tales Dantas Vieira,
  • Karina De Bonis Thomaz,
  • Elias Marcos Silva Flato,
  • Renata Cristina da Silva,
  • Lucas Vicente Andrade,
  • Muna Badaoui,
  • Eduardo Pogetti Badaoui,
  • Miguel Ângelo Goes,
  • Sergio Henrique do Amaral,
  • Karlla Cunha,
  • Inês Marin Muniz,
  • Jacqueline Siqueira Sampaio,
  • Marcelino de Souza Durão Junior,
  • Dirce M. Trevisan Zanetta,
  • Emmanuel A. Burdmann

Journal volume & issue
Vol. 17, no. 1

Abstract

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Introduction Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. Methods This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. Results The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. Conclusion AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).