Introduction
The efficacy of renal replacement therapy (RRT) remains to be validated in COVID-19. In this respective cohort study, we aimed to assess the efficacy of early initiation of RRT in ICU adults with severe COVID-19.
Methods
Fifty-eight adult patients in ICU with critically ill or severe COVID-19 with a tendency of critical illness were recruited from Feb 9, 2020 to Mar 30, 2020. Early RRT were determined by the ICU medical team based on boom in cytokines levels, increased organs injury/failure and rapid aggravation of condition. All participants were followed up from the first day of ICU admission to March 30, 2020. The primary outcome was all-cause mortality in ICU.
Results
The mean age of the cohort was 68.4±14.6 years, with 81.0% had at least one comorbidity before hospitalization. Twenty patients (34.5%) initiated early RRT after 24.1±10.4 days from onset and 6.4±3.6 days from ICU admission. 34 of 58 participants (58.6%) died during ICU follow-up. Univariate and multivariate Cox proportional-hazards model showed that early RRT was associated with a lower risk of all-cause mortality in ICU with an adjusted HR of 0.280 (95% CI 0.106-0.738, p=0.010). Sudden unexpected death (SUD) was remarkably reduced in early RRT group, compared with control group (0.2 vs 2.9 per 100 person-day, p=0.02).
Conclusions
Early RRT can reduce the all-cause in-hospital mortality, especially SUD in patients with severe COVID-19, but not improve multi-organ impairment or increase the risk of AKI. Early initiation of RRT merits an optional strategy in critically ill patients with COVID-19.
No conflict of interest