Context_NN1 
COVID-19_NN1 has_VHZ caused_VVN millions_CRD of_PRF deaths_NN2 worldwide_AV0 since_CJS it_PNP was_VBD reported_VVN in_PRP Wuhan_NP0 ,_PUN China_NP0 ,_PUN in_PRP late_AV0 2019._CRD Nephrologists_NN2 have_VHB been_VBN at_PRP the_AT0 forefront_NN1 of_PRF clinical_AJ0 care_NN1 of_PRF patients_NN2 with_PRP COVID-19_NN1 as_PRP kidney-related_AJ0 complications_NN2 ,_PUN including_PRP acute_AJ0 kidney_NN1 injury_NN1 (_PUL AKI_NP0 )_PUR ,_PUN glomerular_AJ0 disease_NN1 ,_PUN and_CJC severe_AJ0 electrolyte_NN1 derangements_NN2 ,_PUN are_VBB frequently_AV0 encountered_VVN ._SENT In_PRP addition_NN1 to_PRP the_AT0 deleterious_AJ0 effects_NN2 of_PRF COVID-19_NN1 upon_PRP the_AT0 kidneys_NN2 ,_PUN patients_NN2 with_PRP chronic_AJ0 kidney_NN1 disease_NN1 (_PUL CKD_NP0 )_PUR have_VHB been_VBN disproportionately_AV0 impacted_VVN ,_PUN especially_AV0 those_DT0 with_PRP kidney_NN1 failure_NN1 receiving_VVG chronic_AJ0 dialysis_NN1 and_CJC kidney_NN1 transplant_NN1 recipients_NN2 (_PUL KTR_NP0 )_PUR ._SENT 
CKD_NP0 is_VBZ the_AT0 most_AV0 common_AJ0 risk_NN1 factor_NN1 for_PRP death_NN1 in_PRP patients_NN2 with_PRP COVID-19_NN1 worldwide_AV0 ,_PUN and_CJC the_AT0 risk_NN1 increases_VVZ with_PRP higher_AJC CKD_NP0 stage_NN1 ,_PUN with_PRP the_AT0 highest_AJS risk_NN1 occurring_VVG in_PRP those_DT0 with_PRP kidney_NN1 failure_NN1 receiving_VVG replacement_NN1 therapy_NN1 (_PUL KFRT_NP0 )_PUR and_CJC KTR_NP0 ._SENT Furthermore_AV0 ,_PUN patients_NN2 with_PRP KFRT_NP0 receiving_VVG in-center_AJ0 hemodialysis_NN1 are_VBB at_PRP markedly_AV0 higher_AJC risk_NN1 of_PRF COVID-19_NN1 than_CJS those_DT0 receiving_AJ0 home_NN1 dialysis_NN1 therapies_NN2 who_PNQ received_VVD care_NN1 via_PRP telehealth_NN1 ._SENT This_DT0 is_VBZ likely_AV0 explained_VVN by_PRP increased_AJ0 risk_NN1 of_PRF exposure_NN1 of_PRF patients_NN2 receiving_VVG in-center_AJ0 dialysis_NN1 to_PRP SARS-CoV-2_NP0 during_PRP thrice_AV0 weekly_AJ0 travel_NN1 via_PRP group_NN1 or_CJC public_AJ0 transportation_NN1 to_PRP /_PUN from_PRP dialysis_NN1 and_CJC exposure_NN1 to_PRP patients_NN2 and_CJC staff_NN0 at_PRP the_AT0 dialysis_NN1 unit_NN1 ._SENT 
Single-center_AJ0 studies_NN2 reporting_VVG clinical_AJ0 outcomes_NN2 in_PRP patients_NN2 with_PRP CKD_NP0 and_CJC COVID-19_NP0 have_VHB reported_VVN widely_AV0 variable_AJ0 results_NN2 ,_PUN and_CJC this_DT0 variability_NN1 is_VBZ due_AJ0 in_PRP part_NN1 to_PRP differences_NN2 in_PRP patient_AJ0 characteristics_NN2 such_DT0 as_PRP age_NN1 ,_PUN sex_NN1 ,_PUN race_NN1 ,_PUN and_CJC comorbidities_NN2 that_CJT are_VBB associated_VVN with_PRP worse_AJC outcomes_NN2 ._SENT However_AV0 ,_PUN other_AJ0 factors_NN2 ,_PUN including_PRP differences_NN2 in_PRP strain_NN1 upon_PRP medical_AJ0 centers_NN2 due_AJ0 to_PRP large_AJ0 numbers_NN2 of_PRF patients_NN2 with_PRP COVID-19_NN1 ,_PUN heterogeneity_NN1 in_PRP data_NN0 collection_NN1 methods_NN2 ,_PUN methods_NN2 used_VVN to_TO0 ascertain_VVI and_CJC categorize_VVI CKD_NP0 stage_NN1 and_CJC clinical_AJ0 outcomes_NN2 ,_PUN and_CJC study_NN1 time_NN1 points_NN2 ,_PUN affect_VVB reported_AJ0 outcomes_NN2 ._SENT Large_AJ0 multicenter_AJ0 studies_NN2 that_CJT include_VVB a_AT0 diverse_AJ0 array_NN1 of_PRF medical_AJ0 centers_NN2 across_PRP large_AJ0 regions_NN2 and_CJC standardized_AJ0 and_CJC validated_AJ0 methods_NN2 to_TO0 reduce_VVI sources_NN2 of_PRF variability_NN1 are_VBB therefore_AV0 needed_VVN ._SENT 
Subject_NN1 of_PRF Review_NN1 
The_AT0 Study_NN1 of_PRF the_AT0 Treatment_NN1 and_CJC Outcomes_NN2 in_PRP Critically_AV0 Ill_AJ0 Patients_NN2 With_PRP COVID-19_NN1 (_PUL STOP-COVID_NP0 )_PUR is_VBZ a_AT0 multicenter_AJ0 cohort_NN1 study_NN1 involving_VVG 68_CRD medical_AJ0 centers_NN2 across_PRP the_AT0 USA_NP0 and_CJC was_VBD established_VVN in_PRP April_NP0 2020_CRD ,_PUN during_PRP the_AT0 peak_NN1 of_PRF the_AT0 COVID-19_AJ0 surge_NN1 in_PRP the_AT0 northeastern_AJ0 USA_NP0 ._SENT STOP-COVID_NP0 enrolled_VVD consecutive_AJ0 adults_NN2 (_PUL ≥18_CRD years_NN2 )_PUR admitted_VVD to_PRP intensive_AJ0 care_NN1 units_NN2 (_PUL ICU_NN1 )_PUR with_PRP laboratory-confirmed_AJ0 COVID-19_NN1 ._SENT The_AT0 overall_AJ0 goal_NN1 of_PRF STOP-COVID_NN1 is_VBZ to_TO0 identify_VVI independent_AJ0 risk_NN1 factors_NN2 for_PRP hospital_NN1 mortality_NN1 and_CJC acute_AJ0 organ_NN1 injury_NN1 and_CJC to_TO0 identify_VVI treatment_NN1 strategies_NN2 associated_VVN with_PRP improved_AJ0 survival_NN1 (_PUL replaced-url_NP0 )_PUR ._SENT 
In_PRP a_AT0 recently_AV0 published_AJ0 ancillary_AJ0 study_NN1 of_PRF STOP-CO­VID_NN1 ,_PUN Flythe_NP0 et_NP0 al._NN1 focused_VVN upon_PRP clinical_AJ0 outcomes_NN2 in_PRP adults_NN2 with_PRP pre-existing_AJ0 nondialysis-dependent_AJ0 CKD_NP0 (_PUL ND-CKD_NP0 )_PUR or_CJC with_PRP KFRT_NP0 admitted_VVD to_PRP ICU_NN1 with_PRP COVID-19_NN1 between_PRP March_NP0 4_CRD and_CJC May_NP0 10_CRD ,_PUN 2020._CRD Patients_NN2 were_VBD followed_VVN forward_AV0 in_PRP historical_AJ0 time_NN1 from_PRP ICU_NN1 admission_NN1 to_PRP in-hospital_AJ0 death_NN1 ,_PUN hospital_NN1 discharge_NN1 ,_PUN or_CJC June_NP0 6_CRD ,_PUN 2020_CRD ,_PUN when_AVQ the_AT0 database_NN1 was_VBD locked_VVN ._SENT There_EX0 were_VBD 4_CRD ,_PUN 264_CRD individuals_NN2 included_VVN in_PRP the_AT0 study_NN1 ,_PUN 143_CRD (_PUL 3_CRD %_NN0 )_PUR of_PRF whom_PNQ had_VHD pre-existing_AJ0 KFRT_NP0 ,_PUN 521_CRD (_PUL 12_CRD %_NN0 )_PUR with_PRP ND-CKD_NP0 ,_PUN and_CJC 3_CRD ,_PUN 600_CRD (_PUL 85_CRD %_NN0 )_PUR without_PRP CKD_NP0 ._SENT Unsurprisingly_AV0 ,_PUN patients_NN2 with_PRP ND-CKD_NP0 and_CJC KFRT_NP0 had_VHD more_DT0 comorbidities_NN2 ,_PUN including_PRP hypertension_NN1 ,_PUN diabetes_NN1 mellitus_NN1 ,_PUN and_CJC heart_NN1 disease_NN1 ,_PUN than_CJS those_DT0 without_PRP CKD_NP0 ._SENT Of_PRF those_DT0 with_PRP KFRT_NP0 ,_PUN 90_CRD %_NN0 received_VVD in-center_AJ0 hemodialysis_NN1 (_PUL HD_NP0 )_PUR ,_PUN 6_CRD %_NN0 peritoneal_AJ0 dialysis_NN1 (_PUL PD_NP0 )_PUR ,_PUN 1_CRD %_NN0 home_NN1 HD_NP0 ,_PUN and_CJC 3_CRD %_NN0 had_VHD unknown_AJ0 dialysis_NN1 modality_NN1 ._SENT 
Patients_NN2 with_PRP KFRT_NP0 were_VBD admitted_VVN to_PRP the_AT0 ICU_NN1 sooner_AV0 after_PRP hospital_NN1 admission_NN1 (_PUL median_NN1 4_CRD days_NN2 )_PUR than_CJS patients_NN2 with_PRP ND-CKD_NP0 or_CJC those_DT0 without_PRP CKD_NP0 (_PUL 7_CRD days_NN2 )_PUR ._SENT Importantly_AV0 ,_PUN KFRT_NP0 patients_NN2 were_VBD less_AV0 likely_AJ0 to_TO0 have_VHI had_VHN documented_AJ0 COVID-19-related_AJ0 symptoms_NN2 prior_AJ0 to_PRP ICU_NN1 admission_NN1 than_CJS those_DT0 without_PRP CKD_NP0 except_CJS for_PRP altered_AJ0 mental_AJ0 status_NN1 ,_PUN which_DTQ was_VBD more_AV0 common_AJ0 in_PRP those_DT0 with_PRP KFRT_NP0 (_PUL 25_CRD %_NN0 vs._PRP 12_CRD %_NN0 )_PUR ._SENT Patients_NN2 with_PRP KFRT_NP0 also_AV0 were_VBD less_AV0 likely_AJ0 than_CJS those_DT0 without_PRP CKD_NP0 to_TO0 require_VVI mechanical_AJ0 ventilation_NN1 at_PRP the_AT0 time_NN1 of_PRF ICU_NN1 admission_NN1 (_PUL 56_CRD %_NN0 vs._PRP 63_CRD %_NN0 )_PUR ._SENT However_AV0 ,_PUN patients_NN2 with_PRP KFRT_NP0 were_VBD more_AV0 likely_AJ0 to_TO0 require_VVI pressors_NN2 at_PRP ICU_NN1 admission_NN1 (_PUL 50_CRD %_NN0 )_PUR than_CJS those_DT0 with_PRP ND-CKD_NP0 (_PUL 42_CRD %_NN0 )_PUR or_CJC without_PRP CKD_NP0 (_PUL 41_CRD %_NN0 )_PUR ,_PUN though_CJS the_AT0 presence_NN1 of_PRF shock_NN1 ,_PUN defined_VVN as_PRP requirement_NN1 for_PRP 2_CRD or_CJC more_DT0 pressors_NN2 ,_PUN was_VBD similar_AJ0 between_PRP groups_NN2 ._SENT Baseline_NN1 biomarkers_NN2 also_AV0 varied_VVN between_PRP groups_NN2 with_PRP patients_NN2 with_PRP KFRT_NP0 having_VHG lower_AJC white_AJ0 blood_NN1 counts_NN2 ,_PUN platelet_NN1 counts_NN2 ,_PUN and_CJC fibrinogen_NN1 levels_NN2 but_CJC higher_AJC C-reactive_AJ0 protein_NN1 (_PUL CRP_NP0 )_PUR ,_PUN IL-6_CRD ,_PUN ferritin_NN1 ,_PUN and_CJC troponin_NN1 levels_NN2 than_CJS those_DT0 without_PRP CKD_NP0 ._SENT 
Many_DT0 patients_NN2 in_PRP this_DT0 study_NN1 received_VVD interventions_NN2 intended_VVN to_TO0 suppress_VVI SARS-CoV-2_NP0 and_CJC /_PUN or_CJC inflammation_NN1 ,_PUN despite_PRP the_AT0 fact_NN1 that_CJT patients_NN2 in_PRP this_DT0 study_NN1 were_VBD enrolled_VVN before_PRP data_NN0 were_VBD available_AJ0 from_PRP large_AJ0 COVID-19_AJ0 clinical_AJ0 trials_NN2 ,_PUN and_CJC patients_NN2 with_PRP CKD_NP0 were_VBD excluded_VVN from_PRP most_DT0 of_PRF those_DT0 trials_NN2 ._SENT Most_DT0 patients_NN2 received_VVD hydroxychloroquine_NN1 or_CJC chloroquine_NN1 and_CJC fewer_DT0 received_VVD azithromycin_AJ0 or_CJC other_AJ0 antiviral_AJ0 medications_NN2 ._SENT Seven_CRD percent_NN0 of_PRF patients_NN2 without_PRP CKD_NP0 received_VVD remdesivir_NN1 compared_VVN to_PRP 2_CRD %_NN0 of_PRF those_DT0 with_PRP ND-CKD_NP0 and_CJC 0_CRD %_NN0 of_PRF those_DT0 with_PRP KFRT_NP0 ._SENT Although_CJS corticosteroid_AJ0 use_NN1 was_VBD similar_AJ0 across_PRP groups_NN2 ,_PUN those_DT0 without_PRP CKD_NP0 were_VBD more_AV0 likely_AJ0 to_TO0 receive_VVI the_AT0 IL-6_CRD antagonist_NN1 tocilizumab_NN1 (_PUL 19_CRD %_NN0 )_PUR compared_VVN to_PRP those_DT0 with_PRP ND-CKD_NP0 (_PUL 14_CRD %_NN0 )_PUR or_CJC KFRT_NP0 (_PUL 9_CRD %_NN0 )_PUR ._SENT 
In_PRP addition_NN1 to_PRP being_VBG less_AV0 likely_AJ0 to_TO0 require_VVI mechanical_AJ0 ventilation_NN1 at_PRP the_AT0 time_NN1 of_PRF ICU_NN1 admission_NN1 ,_PUN patients_NN2 with_PRP KFRT_NP0 were_VBD less_AV0 likely_AJ0 than_CJS those_DT0 without_PRP CKD_NP0 to_TO0 require_VVI mechanical_AJ0 ventilation_NN1 at_PRP any_DT0 time_NN1 during_PRP hospital_NN1 admission_NN1 (_PUL 74_CRD %_NN0 vs._PRP 80_CRD %_NN0 )_PUR ._SENT Patients_NN2 with_PRP ND-CKD_NP0 or_CJC KFRT_NP0 were_VBD also_AV0 less_AV0 likely_AJ0 to_TO0 require_VVI prone_AJ0 positioning_NN1 than_CJS those_DT0 without_PRP CKD_NP0 ._SENT Laboratory_NN1 parameters_NN2 differed_VVN between_PRP groups_NN2 during_PRP the_AT0 first_ORD 14_CRD days_NN2 of_PRF hospitalization_NN1 ;_PUN patients_NN2 with_PRP KFRT_NP0 and_CJC ND-CKD_NP0 had_VHD persistently_AV0 lower_AJC lymphocyte_NN1 and_CJC platelet_NN1 counts_NN2 and_CJC higher_AJC CRP_NP0 levels_NN2 ._SENT Patients_NN2 with_PRP KFRT_NP0 had_VHD higher_AJC lactate_NN1 levels_NN2 during_PRP the_AT0 first_ORD week_NN1 of_PRF ICU_NN1 care_NN1 compared_VVN to_PRP other_AJ0 groups_NN2 ._SENT 
Patients_NN2 with_PRP ND-CKD_NP0 and_CJC KFRT_NP0 had_VHD significantly_AV0 higher_AJC mortality_NN1 than_CJS those_DT0 without_PRP CKD_NP0 in_PRP unadjusted_AJ0 and_CJC adjusted_AJ0 analyses_NN2 at_PRP 14_CRD and_CJC 28_CRD days_NN2 after_PRP ICU_NN1 admission_NN1 ._SENT At_PRP 28_CRD days_NN2 after_PRP ICU_NN1 admission_NN1 ,_PUN death_NN1 occurred_VVN in_PRP 51_CRD %_NN0 and_CJC 50_CRD %_NN0 of_PRF patients_NN2 with_PRP ND-CKD_NP0 and_CJC KFRT_NP0 but_CJC in_PRP only_AV0 35_CRD %_NN0 of_PRF those_DT0 without_PRP CKD_NP0 ._SENT In_PRP the_AT0 fully_AV0 adjusted_AJ0 model_NN1 (_PUL including_PRP age_NN1 ,_PUN sex_NN1 ,_PUN race_NN1 ,_PUN Hispanic_AJ0 ethnicity_NN1 ,_PUN diabetes_NN1 ,_PUN hypertension_NN1 ,_PUN coronary_AJ0 artery_NN1 disease_NN1 ,_PUN heart_NN1 failure_NN1 ,_PUN and_CJC atrial_AJ0 fibrillation_NN1 or_CJC flutter_NN1 )_PUR ,_PUN the_AT0 hazard_NN1 ratios_NN2 for_PRP 28-day_AJ0 mortality_NN1 were_VBD 1.41_CRD and_CJC 1.25_CRD for_PRP patients_NN2 with_PRP KFRT_NP0 and_CJC ND-CKD_NP0 compared_VVD to_PRP those_DT0 without_PRP CKD_NP0 ._SENT Among_PRP those_DT0 with_PRP KFRT_NP0 ,_PUN those_DT0 dialyzing_NN1 via_PRP a_AT0 catheter_NN1 had_VHD 1.94-fold_AV0 higher_AJC risk_NN1 of_PRF death_NN1 than_CJS those_DT0 dialyzing_NN1 with_PRP an_AT0 arteriovenous_AJ0 vascular_AJ0 access_NN1 ._SENT Among_PRP those_DT0 with_PRP ND-CKD_NP0 ,_PUN there_EX0 was_VBD a_AT0 nonsignificant_AJ0 trend_NN1 toward_PRP higher_AJC mortality_NN1 for_PRP those_DT0 with_PRP baseline_NN1 creatinine_NN1 ≥2_CRD mg_NN0 /_PUN dL_NN1 ._SENT The_AT0 most_AV0 common_AJ0 cause_NN1 of_PRF death_NN1 in_PRP all_DT0 groups_NN2 was_VBD respiratory_AJ0 failure_NN1 ._SENT Patients_NN2 with_PRP KFRT_NP0 had_VHD a_AT0 nonstatistically_AV0 significant_AJ0 trend_NN1 toward_PRP increased_AJ0 secondary_AJ0 outcomes_NN2 ,_PUN including_PRP shock_NN1 ,_PUN ventricular_AJ0 arrhythmia_NN1 /_PUN cardiac_AJ0 arrest_NN1 ,_PUN and_CJC major_AJ0 bleeding_AJ0 events_NN2 ._SENT 
Second_ORD Opinion_NN1 
Important_AJ0 strengths_NN2 of_PRF this_DT0 study_NN1 include_VVB its_DPS large_AJ0 size_NN1 ,_PUN geographical_AJ0 diversity_NN1 (_PUL though_CJS limited_VVN to_PRP the_AT0 USA_NP0 )_PUR ,_PUN standardized_AJ0 data_NN0 collection_NN1 methods_NN2 ,_PUN rigorous_AJ0 statistical_AJ0 analyses_NN2 ,_PUN and_CJC inclusion_NN1 of_PRF consecutive_AJ0 ICU_NN1 admissions_NN2 ,_PUN which_DTQ should_VM0 reduce_VVI selection_NN1 bias_NN1 ._SENT However_AV0 ,_PUN as_CJS acknowledged_VVN by_PRP the_AT0 authors_NN2 ,_PUN there_EX0 are_VBB limitations_NN2 that_CJT may_VM0 affect_VVI the_AT0 interpretation_NN1 of_PRF the_AT0 results_NN2 ._SENT Although_CJS patients_NN2 were_VBD enrolled_VVN consecutively_AV0 ,_PUN data_NN0 were_VBD collected_VVN retrospectively_AV0 ,_PUN and_CJC the_AT0 study_NN1 was_VBD observational_AJ0 ._SENT Therefore_AV0 ,_PUN though_CJS the_AT0 investigators_NN2 attempted_VVD to_TO0 control_VVI for_PRP multiple_AJ0 factors_NN2 ,_PUN it_PNP remains_VVZ possible_AJ0 that_CJT residual_AJ0 confounding_NN1 may_VM0 have_VHI affected_VVN the_AT0 results_NN2 ._SENT Baseline_NN1 CKD_NP0 status_NN1 may_VM0 have_VHI been_VBN misclassified_VVN in_PRP some_DT0 patients_NN2 ,_PUN though_CJS the_AT0 use_NN1 of_PRF hospital_NN1 laboratory_NN1 data_NN0 would_VM0 be_VBI expected_VVN to_TO0 yield_VVI more_DT0 accurate_AJ0 assessment_NN1 of_PRF kidney_NN1 function_NN1 than_CJS the_AT0 use_NN1 of_PRF diagnostic_AJ0 codes_NN2 ._SENT Another_DT0 limitation_NN1 is_VBZ the_AT0 fact_NN1 that_CJT biomarker_NN1 data_NN0 were_VBD missing_VVG for_PRP many_DT0 patients_NN2 ,_PUN and_CJC it_PNP is_VBZ likely_AJ0 that_CJT levels_NN2 were_VBD checked_VVN preferentially_AV0 in_PRP the_AT0 more_AV0 severely_AV0 ill_AJ0 patients_NN2 ,_PUN which_DTQ may_VM0 have_VHI skewed_VVN results_NN2 ._SENT 
Despite_PRP the_AT0 geographic_AJ0 diversity_NN1 of_PRF study_NN1 sites_NN2 from_PRP all_DT0 major_AJ0 regions_NN2 of_PRF the_AT0 USA_NP0 ,_PUN nearly_AV0 all_DT0 were_VBD large_AJ0 academic_AJ0 centers_NN2 and_CJC 58_CRD %_NN0 of_PRF patients_NN2 were_VBD from_PRP the_AT0 northeastern_AJ0 USA_NP0 ._SENT Many_DT0 medical_AJ0 centers_NN2 in_PRP the_AT0 northeastern_AJ0 USA_NP0 experienced_VVD an_AT0 overwhelming_AJ0 surge_NN1 of_PRF COVID-19_NN1 during_PRP spring_NN1 2020_CRD that_CJT necessitated_VVD a_AT0 rapid_AJ0 expansion_NN1 of_PRF ICU_NN1 capacity_NN1 ,_PUN resulting_VVG in_PRP severely_AV0 constrained_VVN nursing_AJ0 and_CJC other_AJ0 resources_NN2 ,_PUN including_PRP the_AT0 capacity_NN1 for_PRP renal_AJ0 replacement_NN1 therapies_NN2 ._SENT STOP-COVID_AJ0 investigators_NN2 have_VHB demonstrated_VVN that_CJT medical_AJ0 center_NN1 strain_NN1 is_VBZ associated_VVN with_PRP increased_AJ0 mortality_NN1 in_PRP critically_AV0 ill_AJ0 patients_NN2 with_PRP COVID-19_NN1 ._SENT Since_PRP this_DT0 study_NN1 was_VBD limited_VVN to_PRP patients_NN2 after_PRP ICU_NN1 admission_NN1 ,_PUN it_PNP is_VBZ also_AV0 possible_AJ0 that_CJT patients_NN2 with_PRP severe_AJ0 ND-CKD_NN1 and_CJC /_PUN or_CJC KFRT_NP0 may_VM0 have_VHI experienced_VVN differences_NN2 in_PRP pre-ICU_AJ0 care_NN1 that_CJT may_VM0 have_VHI affected_VVN outcomes_NN2 and_CJC may_VM0 have_VHI died_VVN prior_AJ0 to_PRP ICU_NN1 admission_NN1 or_CJC been_VBN denied_VVN ICU_NN1 care_NN1 due_AJ0 to_PRP perceived_AJ0 medical_AJ0 futility_NN1 ._SENT However_AV0 ,_PUN if_CJS only_AV0 "_PUQ healthier_AJC "_PUQ patients_NN2 with_PRP severe_AJ0 CKD_NP0 were_VBD admitted_VVN to_PRP ICU_NN1 ,_PUN this_DT0 would_VM0 have_VHI biased_VVN outcomes_NN2 to_TO0 be_VBI better_AJC in_PRP those_DT0 with_PRP ND-CKD_NP0 and_CJC KFRT_NP0 ._SENT 
Clinical_AJ0 outcomes_NN2 for_PRP patients_NN2 with_PRP COVID-19_NN1 have_VHB improved_VVN in_PRP the_AT0 USA_NP0 since_PRP the_AT0 time_NN1 when_AVQ these_DT0 data_NN0 were_VBD collected_VVN ,_PUN likely_AJ0 because_CJS health_NN1 care_NN1 systems_NN2 have_VHB been_VBN less_AV0 severely_AV0 strained_AJ0 and_CJC due_AJ0 to_PRP improvements_NN2 in_PRP pharmacologic_AJ0 and_CJC nonpharmacologic_AJ0 treatments_NN2 ._SENT It_PNP is_VBZ therefore_AV0 possible_AJ0 that_CJT patients_NN2 admitted_VVN to_PRP the_AT0 ICU_NN1 ,_PUN including_PRP those_DT0 with_PRP CKD_NP0 ,_PUN may_VM0 have_VHI better_AJC outcomes_NN2 than_CJS that_DT0 reported_VVN in_PRP this_DT0 article_NN1 ._SENT Although_CJS patients_NN2 with_PRP KFRT_NP0 had_VHD higher_AJC 28-day_AJ0 mortality_NN1 than_CJS those_DT0 without_PRP CKD_NP0 (_PUL 50_CRD %_NN0 vs._PRP 35_CRD %_NN0 )_PUR ,_PUN mortality_NN1 from_PRP single-center_AJ0 studies_NN2 of_PRF KFRT_NP0 patients_NN2 with_PRP COVID-19_NN1 admitted_VVN to_PRP ICUs_NN2 in_PRP the_AT0 USA_NP0 during_PRP the_AT0 same_DT0 time_NN1 period_NN1 was_VBD significantly_AV0 higher_AJC ._SENT The_AT0 reasons_NN2 for_PRP this_DT0 disparity_NN1 are_VBB unclear_AJ0 but_CJC may_VM0 be_VBI explained_VVN in_PRP part_NN1 by_PRP the_AT0 fact_NN1 that_CJT this_DT0 cohort_NN1 comprised_VVD mostly_AV0 large_AJ0 academic_AJ0 medical_AJ0 centers_NN2 ,_PUN and_CJC measures_NN2 of_PRF hospital_NN1 quality_NN1 and_CJC number_NN1 of_PRF ICU_NN1 beds_NN2 are_VBB predictors_NN2 of_PRF mortality_NN1 in_PRP ICU_NN1 patients_NN2 with_PRP COVID-19_NN1 ._SENT It_PNP is_VBZ also_AV0 important_AJ0 to_TO0 note_VVI that_CJT during_PRP the_AT0 spring_NN1 2020_CRD COVID-19_AJ0 surge_NN1 ,_PUN there_EX0 was_VBD a_AT0 large_AJ0 increase_NN1 in_PRP mortality_NN1 among_PRP US_NP0 patients_NN2 with_PRP KFRT_NP0 but_CJC a_AT0 simultaneous_AJ0 large_AJ0 decrease_NN1 in_PRP hospitalizations_NN2 in_PRP these_DT0 patients_NN2 ,_PUN strongly_AV0 suggesting_VVG that_CJT a_AT0 large_AJ0 proportion_NN1 of_PRF patients_NN2 with_PRP KFRT_NP0 and_CJC COVID-19_NP0 died_VVD without_PRP being_VBG hospitalized_VVN ._SENT 
It_PNP is_VBZ unclear_AJ0 why_AVQ patients_NN2 with_PRP severe_AJ0 CKD_NP0 were_VBD less_AV0 likely_AJ0 to_TO0 present_VVI with_PRP classic_AJ0 COVID-19_AJ0 symptoms_NN2 and_CJC more_AV0 likely_AJ0 to_TO0 present_VVI with_PRP atypical_AJ0 symptoms_NN2 such_DT0 as_PRP altered_AJ0 mental_AJ0 status_NN1 ,_PUN but_CJC this_DT0 observation_NN1 should_VM0 alert_VVI clinicians_NN2 to_TO0 be_VBI especially_AV0 vigilant_AJ0 for_PRP COVID-19_NN1 in_PRP patients_NN2 with_PRP CKD_NP0 and_CJC unexplained_AJ0 change_NN1 in_PRP clinical_AJ0 status_NN1 ._SENT It_PNP is_VBZ also_AV0 unclear_AJ0 why_AVQ patients_NN2 with_PRP KFRT_NP0 were_VBD less_AV0 likely_AJ0 to_TO0 require_VVI mechanical_AJ0 ventilation_NN1 in_PRP the_AT0 ICU_NN1 than_CJS patients_NN2 without_PRP CKD_NP0 ._SENT Since_CJS patients_NN2 with_PRP KFRT_NP0 had_VHD a_AT0 higher_AJC prevalence_NN1 of_PRF vasopressor_NN1 use_NN1 at_PRP the_AT0 time_NN1 of_PRF ICU_NN1 admission_NN1 ,_PUN clinicians_NN2 may_VM0 have_VHI admitted_VVN them_PNP to_PRP the_AT0 ICU_NN1 over_PRP concerns_NN2 of_PRF worsening_AJ0 hemodynamics_NN2 during_PRP renal_AJ0 replacement_NN1 therapy_NN1 ._SENT 
The_AT0 reasons_NN2 why_AVQ CKD_NP0 is_VBZ an_AT0 independent_AJ0 risk_NN1 factor_NN1 for_PRP death_NN1 in_PRP patients_NN2 with_PRP COVID-19_NN1 are_VBB poorly_AV0 understood_VVN ._SENT The_AT0 most_AV0 common_AJ0 causes_NN2 of_PRF death_NN1 in_PRP STOP-COVID_NP0 were_VBD respiratory_AJ0 failure_NN1 ,_PUN septic_AJ0 shock_NN1 ,_PUN and_CJC kidney_NN1 failure_NN1 ._SENT The_AT0 presence_NN1 of_PRF severe_AJ0 kidney_NN1 disease_NN1 can_VM0 make_VVI assessment_NN1 and_CJC optimization_NN1 of_PRF volume_NN1 status_NN1 in_PRP patients_NN2 with_PRP respiratory_AJ0 failure_NN1 more_AV0 difficult_AJ0 ._SENT Also_AV0 ,_PUN since_CJS CKD_NP0 is_VBZ a_AT0 potent_AJ0 risk_NN1 factor_NN1 for_PRP AKI_NP0 in_PRP patients_NN2 with_PRP COVID-19_NP0 and_CJC AKI_NP0 is_VBZ strongly_AV0 associated_VVN with_PRP increased_AJ0 mortality_NN1 in_PRP patients_NN2 with_PRP COVID-19_AJ0 ,_PUN increased_AJ0 AKI_NN1 may_VM0 have_VHI contributed_VVN to_PRP excess_AJ0 mortality_NN1 in_PRP ND-CKD_NP0 ._SENT Moreover_AV0 ,_PUN persons_NN2 with_PRP ND-CKD_NP0 and_CJC KFRT_NP0 are_VBB also_AV0 at_PRP increased_AJ0 risk_NN1 of_PRF bacterial_AJ0 infections_NN2 and_CJC poor_AJ0 outcomes_NN2 after_PRP infection_NN1 than_CJS those_DT0 without_PRP CKD_NP0 ._SENT Although_CJS patients_NN2 with_PRP CKD_NP0 did_VDD not_XX0 have_VHI markedly_AV0 increased_VVN prevalence_NN1 of_PRF bacteremia_NN1 at_PRP the_AT0 time_NN1 of_PRF ICU_NN1 admission_NN1 in_PRP STOP-COVID_NN1 ,_PUN it_PNP is_VBZ unclear_AJ0 whether_CJS there_EX0 were_VBD more_DT0 episodes_NN2 of_PRF bacteremia_NN1 during_PRP the_AT0 subsequent_AJ0 ICU_NN1 course_NN1 in_PRP patients_NN2 with_PRP CKD_NP0 ._SENT This_DT0 is_VBZ particularly_AV0 relevant_AJ0 for_PRP patients_NN2 with_PRP KFRT_NP0 since_PRP HD_NP0 catheter_NN1 use_NN1 compared_VVN to_PRP arteriovenous_AJ0 access_NN1 was_VBD associated_VVN with_PRP nearly_AV0 2-fold_AJ0 increased_AJ0 mortality_NN1 in_PRP this_DT0 study_NN1 ._SENT 
Although_CJS the_AT0 increased_AJ0 mortality_NN1 attributable_AJ0 to_PRP CKD_NP0 in_PRP patients_NN2 with_PRP COVID-19_AJ0 likely_AJ0 reflects_VVZ differences_NN2 in_PRP underlying_AJ0 physiology_NN1 ,_PUN including_PRP dysregulated_AJ0 immune_AJ0 responses_NN2 ,_PUN since_CJS these_DT0 patients_NN2 were_VBD less_AV0 likely_AJ0 to_TO0 receive_VVI immunomodulatory_AJ0 and_CJC antiviral_AJ0 therapies_NN2 ,_PUN it_PNP is_VBZ also_AV0 possible_AJ0 that_CJT differences_NN2 in_PRP clinical_AJ0 care_NN1 may_VM0 have_VHI contributed_VVN to_PRP worsened_VVN outcomes_NN2 ._SENT One_CRD of_PRF the_AT0 most_AV0 important_AJ0 results_NN2 from_PRP this_DT0 study_NN1 was_VBD the_AT0 lower_AJC incidence_NN1 of_PRF treatment_NN1 with_PRP emerging_AJ0 therapies_NN2 that_CJT clinicians_NN2 thought_VVN might_VM0 improve_VVI outcomes_NN2 in_PRP COVID-19_NN1 ._SENT Although_CJS some_DT0 ,_PUN such_DT0 as_PRP remdesivir_NN1 ,_PUN are_VBB not_XX0 recommended_VVN for_PRP patients_NN2 with_PRP eGFR_NP0 <_NN1 30_CRD mL_NN0 /_PUN min_NN0 /_PUN 1.73_CRD m2_CRD ,_PUN others_NN2 ,_PUN such_DT0 as_PRP tocilizumab_NN1 ,_PUN are_VBB not_XX0 contraindicated_VVN and_CJC do_VDB not_XX0 require_VVI dose_NN1 adjustment_NN1 for_PRP reduced_AJ0 GFR_NN1 ._SENT Although_CJS the_AT0 limited_AJ0 efficacy_NN1 of_PRF these_DT0 treatments_NN2 would_VM0 not_XX0 fully_AV0 explain_VVI the_AT0 marked_AJ0 difference_NN1 in_PRP mortality_NN1 in_PRP patients_NN2 with_PRP CKD_NP0 ,_PUN there_EX0 may_VM0 have_VHI been_VBN other_AJ0 unmeasured_AJ0 differences_NN2 in_PRP care_NN1 between_PRP those_DT0 with_PRP /_PUN without_PRP CKD_NP0 that_CJT may_VM0 have_VHI influenced_VVN mortality_NN1 ._SENT Unfortunately_AV0 ,_PUN patients_NN2 with_PRP kidney_NN1 disease_NN1 are_VBB often_AV0 denied_VVN potentially_AV0 beneficial_AJ0 medical_AJ0 therapies_NN2 due_AJ0 to_PRP inappropriate_AJ0 concerns_NN2 over_PRP safety_NN1 or_CJC futility_NN1 ._SENT 
