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Sustained low-efficiency dialysis with regional citrate anticoagulation in critically ill patients with COVID-19 associated AKI: A pilot study.
Di Mario, Francesca; Regolisti, Giuseppe; Di Maria, Alessio; Parmigiani, Alice; Benigno, Giuseppe Daniele; Picetti, Edoardo; Barbagallo, Maria; Greco, Paolo; Maccari, Caterina; Fiaccadori, Enrico.
  • Di Mario F; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy. Electronic address: dimariofrancesca@gmail.com.
  • Regolisti G; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy; Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
  • Di Maria A; Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
  • Parmigiani A; Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
  • Benigno GD; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy.
  • Picetti E; 1° Servizio Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Parma, Parma, Italy.
  • Barbagallo M; 2° Servizio Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Parma, Parma, Italy.
  • Greco P; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy.
  • Maccari C; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy.
  • Fiaccadori E; UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università̀ di Parma, Parma, Italy; Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
J Crit Care ; 63: 22-25, 2021 06.
Article in English | MEDLINE | ID: covidwho-1062451
Semantic information from SemMedBD (by NLM)
1. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
2. Kidney Failur PROCESS_OF C0030705
Subject
Kidney Failur
Predicate
PROCESS_OF
Object
C0030705
3. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
5. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
6. Thrombophilia PROCESS_OF Foundation for the Accreditation of Cellular Therapy
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Foundation for the Accreditation of Cellular Therapy
7. Sustained Low-Efficiency Dialysis TREATS Critical Illness
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Critical Illness
8. Sustained Low-Efficiency Dialysis TREATS Patients
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Patients
9. heparin NEG_AUGMENTS American College of Cardiology/American Heart Association Lesion Complexity Score C
Subject
heparin
Predicate
NEG_AUGMENTS
Object
American College of Cardiology/American Heart Association Lesion Complexity Score C
10. Sustained Low-Efficiency Dialysis TREATS Kidney Failur
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Kidney Failur
11. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
12. Kidney Failure, Acute PROCESS_OF Patients
Subject
Kidney Failure, Acute
Predicate
PROCESS_OF
Object
Patients
13. Negative Regulation of Coagulation PROCESS_OF Patients
Subject
Negative Regulation of Coagulation
Predicate
PROCESS_OF
Object
Patients
14. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
15. Thrombophilia PROCESS_OF Patients
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Patients
16. Thrombophilia PROCESS_OF Foundation for the Accreditation of Cellular Therapy
Subject
Thrombophilia
Predicate
PROCESS_OF
Object
Foundation for the Accreditation of Cellular Therapy
17. Sustained Low-Efficiency Dialysis TREATS Critical Illness
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Critical Illness
18. Sustained Low-Efficiency Dialysis TREATS Patients
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Patients
19. heparin NEG_AUGMENTS American College of Cardiology/American Heart Association Lesion Complexity Score C
Subject
heparin
Predicate
NEG_AUGMENTS
Object
American College of Cardiology/American Heart Association Lesion Complexity Score C
20. Sustained Low-Efficiency Dialysis TREATS Kidney Failure, Acute
Subject
Sustained Low-Efficiency Dialysis
Predicate
TREATS
Object
Kidney Failure, Acute
ABSTRACT
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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Citric Acid / Critical Care / Acute Kidney Injury / Hybrid Renal Replacement Therapy / SARS-CoV-2 / COVID-19 / Anticoagulants Type of study: Clinical Practice Guide / Risk factors Topics: Long Covid Limits: Humans / Male / Middle aged Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Citric Acid / Critical Care / Acute Kidney Injury / Hybrid Renal Replacement Therapy / SARS-CoV-2 / COVID-19 / Anticoagulants Type of study: Clinical Practice Guide / Risk factors Topics: Long Covid Limits: Humans / Male / Middle aged Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article