Survival of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in public and private hospitals in Joinville: a cohort study, 2020-2021

Moura, Elviani Basso; Catelano, Bruna de Albuquerque; Aguiar, Fernanda Perito de; Lima, Helbert do Nascimento; França, Paulo Henrique Condeixa de

doi:10.1590/S2237-96222025v34e20240025.en

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Original Article • Epidemiol. Serv. Saúde 34 • 2025 • https://doi.org/10.1590/S2237-96222025v34e20240025.en linkcopy

This document is related to:

10.1590/S2237-96222025v34e20240025.a

This document is related to:

10.1590/S2237-96222025v34e20240025.b

Survival of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in public and private hospitals in Joinville: a cohort study, 2020-2021

Supervivencia de pacientes críticos con COVID-19 y lesión renal aguda en hemodiálisis en hospitales públicos y privados de Joinville: estudio de cohorte, 2020-2021

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To compare the 90-day survival of critically ill people with COVID-19 and acute kidney injury in intensive care units (ICU) of public and private hospitals.

Methods: This was a retrospective cohort study of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in Joinville, Santa Catarina state.

Results: The 90-day survival rate in public ICU was 15.7% (95%CI 8.4; 25.1), while in private ICU it was 37.7% (95%CI 24.9; 50.5%). In the multivariate analysis adjusted for sociodemographic variables (Hazard ratio (HR) 2.01; 95%CI 1.31; 3.08) and comorbidities (HR 2.09; 95%CI 1.30; 3.37), admission to a public ICU was associated with a higher risk of death. After including severity of illness, admission to a public ICU was not associated with an increased risk of death compared to private ICU (HR 0.79; 95%CI 0.45; 1.42).

Conclusion: Measures implemented during the COVID-19 pandemic may have reduced inequalities between health systems for critically ill patients with acute kidney injury.

Keywords:
COVID-19; Acute Kidney Injury; Brazilian National Health System; Supplementary Health; Survival Rate

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[TFN1] Notes: Model 1: sociodemographic variables; Model 2: comorbidity variables; Model 3: severity variables; SAPS=3: Simplified Acute Physiology Score III.

Variables	Private (%)	Public (%)	p-value	Total (%)
Male	38 (71.7)	41 (58.6)	0.133	79 (64.2)
Hypertension	35 (66.0)	37 (52.9)	0.142	72 (58.5)
Diabetes	19 (35.8)	25 (35.7)	0.988	44 (35.8)
Respiratory disease	12 (22.6)	4 (5.7)	0.007	16 (13.0)
Smoking	8 (15.1)	11 (15.7)	0.925	19 (15.4)
Cancer	8 (15.1)	4 (5.7)	0.077	12 (9.8)
Cerebrovascular and cardiovascular diseases	6 (11.3)	3 (4.3)	0.129	9 (7.3)
Use of vasoactive drugs	32 (60.4)	48 (68.6)	0.345	80 (65.0)
Mechanical ventilation	48 (90.6)	70 (100.0)	0.009	118 (95.9)
Death	33 (62.3)	59 (84.3)	0.005	92 (74.8)

Variables	Survival (%)	Death (%)	p-value
Male	16 (51.6)	63 (68.5)	0.090
Hypertension	22 (71.0)	50 (54.3)	0.104
Diabetes	11 (35.5)	33 (35.9)	0.969
Respiratory disease	4 (12.9)	12 (13.0)	0.627
Smoking	2 (6.4)	17 (18.5)	0.089
Cancer	2 (6.4)	10 (10.9)	0.374
Cerebrovascular and cardiovascular diseases	3 (9.7)	6 (6.5)	0.405
Use of vasoactive drugs	10 (32.3)	70 (76.1)	<0.001
Mechanical ventilation	26 (83.9)	92 (100.0)	<0.001
Private hospital	20 (64.5)	33 (35.9)	0.005
Public hospital	11 (35.5)	59 (64.1)	0.005

Variables	Crude HR (95%CI)	p-value	Adjusted HR (95%CI)	p-value
Hospital
Private	1.00
Public	1.93 (1.26; 2.97)	0.003
Sex
Male			1.00
Female			1.98 (1.29; 3.05)	0.002
Hypertension
No			1.00
Yes			1.85 (1.19; 2.86)	0.006
Diabetes
No			1.00
Yes			1.93 (1.26; 2.97)	0.003
Respiratory disease
No			1.00
Yes			2.01 (1.29; 3.14)	0.002
Cerebrovascular and cardiovascular diseases
No			1.00
Yes			1.92 (1.24; 2.96)	0.003
Cancer
No
Yes			2.06 (1.32; 3.20)	0.001
Use of vasoactive drugs
No			1.00
Yes			1.68 (1.09; 2.59)	0.019
Smoking
No			1.00
Yes			1.91 (1.24; 2.94)	0.003
Age (year increase)			1.96 (1.28; 3.02)	0.002
Duration of mechanical ventilation (days/unit increase)			1.16 (0.75; 1.79)	0.501
Severity (unit increase)			1.35 (0.79; 2.30)	0.276

Variables	Model 1		Model 2		Final model
Variables	HC (95%CI)	p-value	HC (95%CI)	p-value	HC (95%CI)	p-value
Type of hospital (public/private)	2.01 (1.31; 3.08)	0.001	2.09 (1.30; 3.37)	0.003	0.79 (0.45; 1.42)	0.440
Age (year increase)	1.02 (1.01; 1.04)	0.006	1.02 (1.00; 1.04)	0.015	1.01 (0.99; 1.03)	0.152
Sex
male	1.00		1.00		1.00
female	0.76 (0.48; 1.18)	0.219	0.78 (0.49; 1.24)	0.297	0.90 (0.56; 1.44)	0.654
Diabetes
Yes			1.00		1.00
No			0.99 (0.64; 1.53)	0.949	1.01 (0.64; 1.59)	0.976
Respiratory disease
Yes			1.00		1.00
No			1.19 (0.61; 2.30)	0.614	1.31 (0.64; 2.69)	0.460
Cerebrovascular and cardiovascular diseases
Yes			1.00		1.00
No			0.78 (0.33; 1.84)	0.567	0.85 (0.35; 2.02)	0.706
Cancer
Yes			1.00		1.00
No			1.25 (0.58; 2.67)	0.569	1.64 (0.74; 3.63)	0.223
Use of vasoactive drugs
Yes					1.00
No					1.08 (0.64; 1.84)	0.768
Duration of mechanical ventilation (days/unit increase)					0.96 (0.94; 0.97)	<0.001
Severity (unit increase)					1.03 (1.00; 1.05)	0.013