“Previous studies reported that 65% to 70% of patients with acute kidney injury requiring kidney replacement therapy (AKI-KRT) had recovered from dialysis dependency at the time of hospital discharge. However, long-term renal outcomes are unknown, because post-hospital follow-up after COVID-19-associated AKI in previous studies was limited to short observational periods,” wrote Kai M Schmidt-Ott, Charité-Universitätsmedizin, Berlin, Germany, and colleagues.
In the study, researchers retrospectively analysed renal outcomes in 74 hospitalised patients (median age, 65 years; 74.3% male) with COVID-19 and AKI-KRT in a tertiary care centre in Berlin between March and June 2020. The median baseline estimated glomerular filtration rate was 76.5 ml/min per 1.73 m2. All patients were treated in intensive care units at the time of AKI-KRT onset. COVID-19-specific therapies included corticosteroids (68%), hydroxychloroquine (4.1%), anakinra (8.1%), immunoglobulins (6.8%), tocilizumab (1.4%), and lopinavir-ritonavir (1.4%).
After a median follow-up of 151 days (interquartile range 128-192 days) post-initiation of KRT, 36 patients (48.6%) had died during hospitalisation, 37 (50%) had been discharged while 1 patient remained hospitalised. Among discharged survivors, the median overall duration of kidney replacement therapy was 27 days (interquartile range 11-50 days). At the end of follow-up, 3 (8.1%) patients were KRT-dependent while the remaining 34 (91.9%) patients had achieved variable degrees of renal recovery, including 23 (62.2%) patients with full renal recovery.
“These findings indicate that kidney recovery is common in COVID-19 survivors even after long periods of KRT requirement during AKI,” the authors concluded. “This information may be of value for patients with COVID-19 and their clinicians when it comes to deciding about the initiation or continuation of KRT.”