ABSTRACT
Background: Studies indicate that 5% of patients with COVID-19 develop critical illness, warranting ICU level of care. Up to 15% of these critically ill patients develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). COVID-19 also appears to generate a pro-thrombotic state in some patients and thrombosis during CRRT could prevent life sustaining clearance and fluid removal. Methods: In this single center study, we performed a retrospective chart review of patients admitted to Montefiore Medical Center, with a confirmed diagnosis of COVID19 in an ICU requiring CRRT between 3/10/2020 - 4/28/2020. Subsequently, we categorized the different anticoagulation (AC) types that were used for each CRRT treatment: no AC, heparin, bivalirudin, apixiban. The primary outcome was to determine the percent of achieved versus prescribed CRRT in patients treated without AC, heparin, or bivalirudin (dosing >;0.25 mg/kg/hr, versus < 0.25 mg/kg/hr). The secondary outcome was to determine the percent reduction in BUN and potassium within 10 hours of CRRT. Results: We excluded patients with renal failure requiring renal replacement therapy (RRT) that did not have a confirmed diagnosis of COVID19, as well as patients with a previous history of thrombosis. We were left with 69 patients, whom we analyzed the first three RRT treatments of each patient. The average age was 59.48 years, 81.2% male, 18.8% female. 15% of patients were African American, 5% Caucasian, 31% Hispanic, and 17% identified as other. The average BMI was 30.2. 40% of patients had diabetes mellitus, 49% hypertension, and 14% CKD or ESRD. We analyzed a total of 162 RRT treatments. Of these 162 treatments, 49% of patients received bivalirudin, 27% heparin, and 23.4% did not receive AC. We found that 84.5% of patients receiving bivalirudin completed their CRRT treatment, 77.7% receiving heparin completed treatment, and 59.3% of patients not on AC completed treatment. Conclusions: Patients with a confirmed diagnosis of COVID 19 that are critically ill and receive CRRT are more likely to finish their CRRT treatment, and therefore achieved improved clearance, if they were given some form of AC to prevent clotting.