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Review
. 2021;50(4-5):610-620.
doi: 10.1159/000513214. Epub 2020 Dec 15.

COVID-19 in ESRD and Acute Kidney Injury

Jeroen P Kooman  1 , Frank M van der Sande  2
Affiliations
Review

COVID-19 in ESRD and Acute Kidney Injury

Jeroen P Kooman et al. Blood Purif. 2021.

Abstract

The COVID-19 pandemic has greatly affected nephrology. Firstly, dialysis patients appear to be at increased risk for infection due to viral transmission next to an enhanced risk for mortality as compared to the general population, even in the face of an often apparently mild clinical presentation. Derangements in the innate and adaptive immune systems may be responsible for a reduced antiviral response, whereas chronic activation of the innate immune system and endothelial dysfunction provide a background for a more severe course. The presence of severe comorbidity, older age, and a reduction of organ reserve may lead to a rapid deterioration of the clinical situation of the patients in case of severe infection. Secondly, patients with COVID-19 are at increased risk of acute kidney injury (AKI), which is related to the severity of the clinical disease. The presence of AKI, and especially the need for renal replacement therapy (RRT), is associated with an increased risk of mortality. AKI in COVID-19 has a multifactorial origin, in which direct viral invasion of kidney cells, activation of the renin-angiotensin aldosterone system, a hyperinflammatory response, hypercoagulability, and nonspecific factors such as hypotension and hypoxemia may be involved. Apart from logistic challenges and the need for strict hygiene within units, treatment of patients with ESRD and COVID-19 is not different from that of the general population. Extracorporeal treatment of patients with AKI with RRT can be complicated by frequent filter clotting due to the hypercoagulable state, for which regional citrate coagulation provides a reasonable solution. Also, acute peritoneal dialysis may be a reasonable option in these patients. Whether adjuncts to extracorporeal therapies, such as hemoadsorption, provide additional benefits in the case of severely ill COVID-19 patients needs to be addressed in controlled studies.

Keywords: COVID-19; Dialysis; Kidney; Pathophysiology.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Possible mechanisms behind the increased susceptibility of dialysis patients to SARS-CoV-2 infection. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Fig. 2
Fig. 2
Possible mechanisms behind CO­VID-19 and acute renal failure. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; NK, natural killer.
See this image and copyright information in PMC

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