Kidney replacement therapy in COVID-19-Related acute kidney injury: The impact of timing on mortality.

Autor: de Almeida CAP; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., de Oliveira MFA; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Teixeira AM; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Cabrera CPS; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Smolentzov I; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Reichert BV; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Gessolo Lins PR; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Rodrigues CE; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Seabra VF; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil., Andrade L; Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Oct 24; Vol. 19 (10), pp. e0309655. Date of Electronic Publication: 2024 Oct 24 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0309655
Abstrakt: The objective of this study was to determine the impact of the timing of KRT, dichotomized by a temporal criterion or by creatinine level, in patients with COVID-19-related AKI. This was a retrospective study involving 512 adult patients admitted to the ICU. All participants had laboratory-confirmed COVID-19 and a confirmed diagnosis of AKI. The potential predictors were the determination of the timing of KRT based on a temporal criterion (days since hospital admission) and that based on a serum creatinine cutoff criterion. Covariates included age, sex, and the SOFA score, as well as the need for mechanical ventilation and vasopressors. The main outcome measure was in-hospital mortality. We evaluated 512 patients, of whom 69.1% were men. The median age was 64 years. Of the 512 patients, 76.6% required dialysis after admission. The overall in-hospital mortality rate was 72.5%. When the timing of KRT was determined by the temporal criterion, the risk of in-hospital mortality was significantly higher for later KRT than for earlier KRT-84% higher in the univariate analysis (OR = 1.84, 95%, [CI]: 1.10-3.09) and 140% higher after adjustment for age, sex, and SOFA score (OR = 2.40, 95% CI: 1.36-4.24). When it was determined by the creatinine cutoff criterion, there was no such difference between high and low creatinine at KRT initiation. In patients with COVID-19-related AKI, earlier KRT might be associated with lower in-hospital mortality.
Competing Interests: The authors have read the journal’s policy and have the following competing interests: CAPdA is a member of the Global Medical Review team at Eli Lilly and Company (https://www.lilly.com/). PRGL started working at Baxter Brasil in June/2023. VFS received a consulting fee for participation on an Advisory Board meeting in March 2022 for Vifor Pharma Brazil (https://www.cslvifor.com.br/) outside of the submitted work. CER received fees from Medtronic for providing instruction in catheter insertion in 2021 outside of the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
(Copyright: © 2024 de Almeida et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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