Asunto(s)
Lesión Renal Aguda/terapia , COVID-19/complicaciones , Terapia de Reemplazo Renal Híbrido/métodos , Rol de la Enfermera , Lesión Renal Aguda/virología , Adulto , COVID-19/terapia , Alarmas Clínicas , Enfermería de Cuidados Críticos , Femenino , Humanos , Terapia de Reemplazo Renal Híbrido/efectos adversos , Enfermería en Nefrología , Grupo de Atención al Paciente , SARS-CoV-2RESUMEN
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.
Asunto(s)
Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/terapia , Anticoagulantes/uso terapéutico , COVID-19/complicaciones , Ácido Cítrico/uso terapéutico , Cuidados Críticos/métodos , Terapia de Reemplazo Renal Híbrido/métodos , SARS-CoV-2 , Coagulación Sanguínea/efectos de los fármacos , COVID-19/virología , Enfermedad Crítica , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Resultado del TratamientoRESUMEN
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.