Incidence of major adverse kidney events after ICU admission in COVID-19 and non-COVID-19 ARDS patients.

Abstract

To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes. Retrospective cohort study. Single-centre intensive care unit in the Midlands, UK. 708 ARDS patients (458 COVID-19, 250 non-COVID-19). The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) <75% of baseline or all-cause mortality. Secondary analyses examined non-mortality MAKE components. The incidence of MAKE-365 was significantly higher in the non-COVID-19 group compared with the COVID-19 group (66% vs 39%, p<0.001), primarily driven by increased RRT initiation, followed by mortality and eGFR decline (p=0.055). Independent predictors of MAKE-365 included lower eGFR and elevated bilirubin in both groups. Age (p<0.001) and diabetes (p=0.041) were additional predictors in the COVID-19 cohort, while lower albumin (p=0.002) was significant in the non-COVID-19 group. Excluding mortality, RRT and eGFR decline remained significant drivers of MAKE outcomes in the non-COVID-19 cohort. Non-COVID-19 ARDS patients face a greater risk of MAKE-365 and adverse kidney outcomes due to higher RRT requirements and mortality rates. These findings underscore the importance of tailored interventions and long-term nephrology follow-up, particularly for patients with reduced eGFR, elevated bilirubin and comorbidities like diabetes and hypoalbuminaemia.