1. 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
- Author
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Reena Mehta, Jonathan D.W. Clarke, Khaled Al-Arfi, Richard Fisher, Eirini Lioudaki, Clemens Pahl, Kate Bramham, Claire C. Sharpe, Rohit Saha, and Sam Hutchings
- Subjects
Male ,UF, Ultrafiltration ,medicine.medical_treatment ,IHD, Intermittent Haemodialysis ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,law.invention ,Tertiary Care Centers ,0302 clinical medicine ,law ,Pandemic ,RRT, Renal Replacement Therapy ,CRE, Carbapenem Resistant Enterobaceriae ,CRRT, Continuous Renal Replacement Therapy ,Incidence (epidemiology) ,Acute kidney injury ,Acute Kidney Injury ,Middle Aged ,Intensive care unit ,female genital diseases and pregnancy complications ,APD, Automated Pertioneal Dialysis ,Haemodialysis ,Intensive Care Units ,SLED, Sustained Low-Efficiency Dialysis ,CCPD, Continuous Cyclic Peritoneal Dialysis ,Female ,Peritoneal Dialysis ,RO, Reverse Osmosis ,Adult ,medicine.medical_specialty ,RT-PCR, Real-Time Polymerase Chain Reaction ,Continuous Renal Replacement Therapy ,Critical Care ,Coronavirus disease 2019 (COVID-19) ,CVVHDF, Continuous Veno-Venous HaemoDiaFiltration ,PIRRT, Prolonged Intermittent Renal Replacement Therapy ,ESKD, End Stage Kidney Disease ,Article ,Intermittent Renal Replacement Therapy ,Peritoneal dialysis ,03 medical and health sciences ,medicine ,Humans ,Renal replacement therapy ,Aged ,Retrospective Studies ,Modalities ,AKI, Acute Kidney Injury ,SARS-CoV-2 ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,medicine.disease ,United Kingdom ,030228 respiratory system ,Emergency medicine ,business ,CKD, Chronic Kidney Disease - 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., Highlights • AKI frequently complicates COVID-19 in patients admitted to ICU. • Large numbers of patients and high rates of AKI leads to great demand for RRT. • In selected patients PD and IHD can supplement CRRT in meeting this demand. • PD and IHD can be implemented rapidly and safely through a collaborative approach.
- Published
- 2021
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