Short‐term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy

2021 ◽  
Author(s):  
Wenqian Wei ◽  
Shu Rong ◽  
Xianchen Li ◽  
Man Yang ◽  
Lijie Gu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Influencing Factors ◽  
Kidney Injury ◽  
Short Term ◽  
Intermittent Renal Replacement Therapy

scholarly journals Prolonged Intermittent Renal Replacement Therapy for Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome

2020 ◽  
pp. 1-9
Author(s):  
Juan C. Ramirez-Sandoval ◽  
Jorge E. Gaytan-Arocha ◽  
Pedro Xolalpa-Chávez ◽  
Juan M. Mejia-Vilet ◽  
Mauricio Arvizu-Hernandez ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Intradialytic Hypotension ◽  
Intermittent Renal Replacement Therapy

<b><i>Introduction:</i></b> Patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 frequently develop severe acute kidney injury (AKI). Although continuous renal replacement therapy is the standard of care for critically ill patients, prolonged intermittent renal replacement therapy (PIRRT) may be a feasible option. We aimed to describe the tolerability and security of PIRRT treatments in COVID-19 patients with ARDS who required mechanical ventilation and developed severe AKI. <b><i>Methods:</i></b> We prospectively analyzed patients who underwent PIRRT treatments at a COVID-19 reference hospital in Mexico City. Intradialytic hypotension was defined as a systolic blood pressure decrease of ≥20 mm Hg or an increase of 100% in vasopressor dose. <b><i>Results:</i></b> We identified 136 AKI cases (60.7%) in 224 patients admitted to the intensive care unit. Among them, 21 (15%) underwent PIRRT (130 sessions) due to stage 3 AKI. The median age of the cohort was 49 (range 36–73) years, 17 (81%) were male, 7 (33%) had diabetes, and the median time between symptoms onset and PIRRT initiation was 12 (interquartile range [IQR] 7–14) days. The median of PIRRT procedures for each patient was 5 (IQR 4–9) sessions. In 108 (83%) PIRRT sessions, the total ultrafiltration goal was achieved. In 84 (65%) PIRRT procedures, there was a median increase in norepinephrine dose of +0.031 mcg/kg/min during PIRRT (IQR 0.00 to +0.07). Intradialytic hypotensive events occurred in 56 (43%) procedures. Fifteen (12%) PIRRT treatments were discontinued due to severe hypotension. Vasopressor treatment at PIRRT session onset (OR 6.2, 95% CI 1.4–28.0, <i>p</i>: 0.02) and a pre-PIRRT lactate ≥3.0 mmol/L (OR 4.63, 95% CI 1.3–12.8, <i>p</i>: 0.003) were independently and significantly associated with the risk of hypotension during PIRRT. During follow-up, 11 patients (52%) recovered from AKI and respiratory failure and 9 (43%) died. Several adaptations to our PIRRT protocol during the COVID-19 outbreak are presented. <b><i>Conclusions:</i></b> PIRRT was feasible in the majority of COVID-19 patients with ARDS and severe AKI, despite frequent transitory intradialytic hypotensive episodes. PIRRT may represent an acceptable alternative of renal replacement therapy during the COVID-19 outbreak.

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