CLINICAL CHARACTERISTICS, MANAGEMENT AND OUTCOMES OF CRITICALLY ILL COVID-19 PATIENTS UNDERGOING CRRT: COMPARISON BETWEEN THE FIRST TWO PANDEMIC WAVES
Nephrology Dialysis Transplantation
; 37(SUPPL 3):i209-i211, 2022.
Article
in English
| EMBASE | ID: covidwho-1915692
ABSTRACT
BACKGROUND AND AIMS:
Acute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), which, particularly in critically ill patients requiring continuous renal replacement therapy (CRRT), is associated with an elevated mortality risk [1, 2]. However, knowledge about COVID-19 pathogenesis and management is evolving, and clinical practice is changing rapidly. Here, we evaluated if this process had an impact on the management and outcome of AKI patients.METHODS:
We performed a retrospective observational study on critically ill adult COVID-19 patients who received CRRT in the intensive care unit (ICU) during the first two pandemic waves before the availability of COVID-19 vaccines the first one from March to August 2020 (first) and the second one (second) from September to December 2020.RESULTS:
Overall, we considered 63 patients, aged 65 (60-69) years, 76.2% males. The main comorbidities were diabetes (DM), cardiovascular disease (CVD) and chronic kidney disease (CKD). Among them, 28 (44%) were in the first group and 35 (66%) in the second group. There were no significant differences in general characteristics, such as in comorbidities, except for a higher prevalence of CVD in the first group (Fig. 1). Lab examinations at ICU admission, including serum creatinine level (sCr), were not different between the two groups. While all patients required respiratory support, non-invasive ventilation was more prevalent in the second wave. Notably, during this period, decapneization combined with CRRT was introduced. Regarding drugs, we found that in the second group, hydroxychloroquine was abandoned, tocilizumab use was reduced and heparin administration significantly increased. The AKI time course was similar between the patients of the two waves (Fig. 2). There were no significant differences in CRRT techniques. However, in the second, the use of additional CRRT-devices, in particular adsorption-based filters, significantly increased. In most cases, citrate anticoagulation was used in both groups. Looking at the outcomes, we found no significant difference between the two waves. Indeed, 17 (60.2%) and 22 (62.8%) patients died in the ICU in the first and second groups, respectively. The length of ICU hospitalization, days on CRRT, invasive ventilation and DM were significantly related to overall mortality;time of ICU hospitalization was the only remaining significant at multivariate Cox regression. Overall, 21 (33%) patients survived hospitalization. At the 6 months after the discharge, 3 of them died, 3 were on HD and 15 were dialysis-free, even if 6 of them presented CKD.CONCLUSION:
Our data confirm the high complexity and mortality of COVID-19 patients undergoing CRRT. Comparing the first two pandemic waves, we found that the patients also presented similar characteristics in terms of renal function and AKI time course. Regarding treatments, we observed some significant modifications in the management of ventilation, drug administration and dialysis membranes, mainly because of the results of ongoing clinical trials. However, these changes did not impact patients' outcomes. These data support the view that only game-change strategies, such as vaccination or infection-specific drugs, may impact the presentation and outcome of COVID-19 patients undergoing CRRT. Finally, patients surviving this condition deserve special attention in the follow-up. (Table Presented).
heparin; hydroxychloroquine; tocilizumab; vaccine; acute kidney failure; adsorption; adult; aged; all cause mortality; anticoagulation; assisted ventilation; attention; cardiovascular disease; chronic kidney failure; clinical feature; clinical trial; comorbidity; conference abstract; controlled study; coronavirus disease 2019; creatinine blood level; critically ill patient; diabetes mellitus; dialysis membrane; drug therapy; female; filter; follow up; hospitalization; human; human tissue; intensive care unit; invasive ventilation; kidney function; major clinical study; male; mortality; noninvasive ventilation; observational study; outcome assessment; pandemic; prevalence; retrospective study; vaccination
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Nephrology Dialysis Transplantation
Year:
2022
Document Type:
Article
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