Introduction
Acute kidney injury treated with kidney replacement therapy (AKI-KRT), represents a frequent and severe complication of COVID-19 disease. While the in-hospital mortality of these patients is high, little is known about the kidney prognosis of survivors, particularly in the post-hospital setting.
Methods
We retrospectively identified all COVID-19 patients with AKI-KRT (n=74) admitted to a large tertiary care center in Berlin, Germany, between March and June 2020 and assessed kidney outcomes (grade of kidney recovery (full/partial), eGFR and need for dialysis) at hospital discharge and during post-hospital follow up (need for dialysis).
Results
Patients were predominantly male (74.3%), median age was 64.5 years and about 20% had preexisting CKD ≥ CKD G3 (median baseline eGFR 76.5 ml/min/1.73m2). All patients were treated in the ICU at time of AKI-KRT onset. 98.6% of patients were mechanically ventilated, 39.2% received ECMO therapy. By October 21st, 2020, 37 (50 %) were discharged from acute care 36 (48.6%) had died and one patient (1.4%) continued to be in the intensive care unit. At the time of hospital discharge 25 (67.6 % of discharged patients) showed full renal recovery defined as not even meeting the criteria for AKI stage 1 anymore. Twelve patients fulfilled the criteria of acute kidney disease (AKD), including seven patients (18.9% of discharged patients) continuing to be dependent on KRT. Median eGFR at hospital discharge in surviving patients no longer requiring KRT was 71.2 ml/min/1.73m2. During a median follow-up time of 95 days (IQR 64-133) after discharge in 35/37 patients with follow-up data all but one patient (97.3%) had recovered from dialysis dependency. Two patients had recurrent AKI-KRT secondary to acute illness. No deaths occurred after hospital discharge.
Conclusions
Dialysis-dependent AKI in COVID-19 patients is associated with a high in-hospital mortality, but in survivors kidney recovery is common even after a long course of dialysis-dependency.
No conflict of interest