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J Crit Care ; 63: 22-25, 2021 06.
Article in English | MEDLINE | ID: covidwho-1062451


Acute Kidney Injury (AKI) is a frequent complication in critically ill patients with Coronavirus disease 2019 (COVID-19), and it has been associated with worse clinical outcomes, especially when Kidney Replacement Therapy (KRT) is required. A condition of hypercoagulability has been frequently reported in COVID-19 patients, and this very fact may complicate KRT management. Sustained Low Efficiency Dialysis (SLED) is a hybrid dialysis modality increasingly used in critically ill patients since it allows to maintain acceptable hemodynamic stability and to overcome the increased clotting risk of the extracorporeal circuit, especially when Regional Citrate Anticoagulation (RCA) protocols are applied. Notably, given the mainly diffusive mechanism of solute transport, SLED is associated with lower stress on both hemofilter and blood cells as compared to convective KRT modalities. Finally, RCA, as compared with heparin-based protocols, does not further increase the already high hemorrhagic risk of patients with AKI. Based on these premises, we performed a pilot study on the clinical management of critically ill patients with COVID-19 associated AKI who underwent SLED with a simplified RCA protocol. Low circuit clotting rates were observed, as well as adequate KRT duration was achieved in most cases, without any relevant metabolic complication nor worsening of hemodynamic status.

Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Anticoagulants/therapeutic use , COVID-19/complications , Citric Acid/therapeutic use , Critical Care/methods , Hybrid Renal Replacement Therapy/methods , SARS-CoV-2 , Blood Coagulation/drug effects , COVID-19/virology , Critical Illness , Heparin/therapeutic use , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome
Adv Chronic Kidney Dis ; 27(5): 377-382, 2020 09.
Article in English | MEDLINE | ID: covidwho-796111


Acute kidney injury is a common complication in hospitalized patients with coronavirus disease 2019. Similar to acute kidney injury associated with other conditions such as sepsis and cardiac surgery, morbidity and mortality are much higher in patients with coronavirus disease 2019 who develop acute kidney injury, especially in the intensive care unit. Management of coronavirus disease 2019-associated acute kidney injury with kidney replacement therapy should follow existing recommendations regarding modality, dose, and timing of initiation. However, patients with coronavirus disease 2019 are very hypercoagulable, and close vigilance to anticoagulation strategies is necessary to prevent circuit clotting. During situations of acute surge, where demand for kidney replacement therapy outweighs supplies, conservative measures have to be implemented to safely delay kidney replacement therapy. A collaborative effort and careful planning is needed to conserve dialysis supplies, to ensure that treatment can be safely delivered to every patient who will benefit for kidney replacement therapy.

Acute Kidney Injury/therapy , Anticoagulants/therapeutic use , COVID-19/therapy , Renal Replacement Therapy/methods , Thrombophilia/drug therapy , COVID-19/blood , Catheterization, Central Venous , Central Venous Catheters , Citric Acid/therapeutic use , Continuous Renal Replacement Therapy/methods , Hemodialysis Solutions/supply & distribution , Hemoperfusion/methods , Heparin/therapeutic use , Humans , Hybrid Renal Replacement Therapy/methods , Intermittent Renal Replacement Therapy/methods , Kidneys, Artificial/supply & distribution , Partial Thromboplastin Time , Renal Replacement Therapy/instrumentation , SARS-CoV-2 , Surge Capacity , Thrombophilia/blood