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. 2021 Apr:62:190-196.
doi: 10.1016/j.jcrc.2020.12.023. Epub 2020 Dec 28.

Provision of acute renal replacement therapy, using three separate modalities, in critically ill patients during the COVID-19 pandemic. An after action review from a UK tertiary critical care centre

Richard Fisher  1 , Jonathan Clarke  2 , Khaled Al-Arfi  3 , Rohit Saha  4 , Eirini Lioudaki  5 , Reena Mehta  6 , Clemens Pahl  7 , Claire Sharpe  8 , Kate Bramham  9 , Sam Hutchings  10
Affiliations

Provision of acute renal replacement therapy, using three separate modalities, in critically ill patients during the COVID-19 pandemic. An after action review from a UK tertiary critical care centre

Richard Fisher et al. J Crit Care. 2021 Apr.

Abstract

Purpose: The aim of this study is to describe the incidence of Acute Kidney Injury (AKI) amongst patients admitted to the Intensive Care Unit (ICU) with COVID-19. In addition we aim to detail the range of Renal Replacement Therapy (RRT) modalities offered to these patients (including peritoneal dialysis - PD - and intermittent haemodialysis - IHD) in order to meet demand during pandemic conditions.

Materials and methods: Single-centre retrospective case note review of adult patients with confirmed COVID-19 admitted to ICU.

Results: Amongst 136 patients without a prior history of End Stage Kidney Disease (ESKD), 108 (79%) developed AKI and 63% of admitted patients received RRT. Due to resource limitations the range of RRT options were expanded from solely Continuous Veno-Venous HaemoDiaFiltration (CVVHDF - our usual standard of care) to include PD (in 35 patients) and IHD (in 15 patients). During the study period the proportion of RRT provided within ICU as CVVHDF fell from 100% to a nadir of 39%. There were no significant complications of either PD or IHD.

Conclusions: During periods of resource limitations PD and IHD can safely be used to reduce dependence on CVVHDF in select patients with AKI secondary to COVID-19.

Keywords: Acute kidney injury; COVID-19; Haemodialysis; Peritoneal Dialysis; Renal replacement therapy.

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Conflict of interest statement

Declaration of Competing Interest All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Timeline of interventions introduced to maximise availability of RRT for patients with COVID-19 and severe AKI.
Fig. 2
Fig. 2
Percentage of patients receiving RRT, receiving CRRT.
Fig. 3
Fig. 3
Number of patients admitted to critical care with COVID-19 over time (by modality of RRT received).
See this image and copyright information in PMC

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References

    1. ICNARC . 2020. ICNARCreport on COVID-19 in critical care 05 June 2020.
    1. Wang D., Hu B., Hu C., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Yang X., Yu Y., Xu J., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational. Lancet Respir Med. 2020;8(5):475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Gabarre P., Dumas G., Dupont T., Darmon M., Azoulay E., Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020:1–10. doi: 10.1007/s00134-020-06153-9. - DOI - PMC - PubMed