Provision of acute renal replacement therapy, using three separate modalities, in critically ill patients during the COVID-19 pandemic. An after action review from a UK tertiary critical care centre

• Published in: Journal of critical care Vol. 62; pp. 190 - 196
• Main Authors: Fisher, Richard, Clarke, Jonathan, Al-Arfi, Khaled, Saha, Rohit, Lioudaki, Eirini, Mehta, Reena, Pahl, Clemens, Sharpe, Claire, Bramham, Kate, Hutchings, Sam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021; Elsevier Limited; Published by Elsevier Inc
• Subjects: Acute kidney injury; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Adult; Aged; Continuous Renal Replacement Therapy - methods; Coronaviruses; COVID-19; COVID-19 - complications; Critical Care - methods; Female; Haemodialysis; Hemodialysis; Humans; Intensive care; Intensive Care Units; Intermittent Renal Replacement Therapy - methods; Male; Middle Aged; Mortality; Peritoneal Dialysis; Peritoneal Dialysis - statistics & numerical data; Renal replacement therapy; Renal Replacement Therapy - methods; Retrospective Studies; SARS-CoV-2; Tertiary Care Centers; United Kingdom - epidemiology; United Kingdom; United Kingdom > UK; United States > US; Illinois; IHD; Acute kidney injury; ESKD; Haemodialysis; CCPD; CRRT; COVID-19; UF; PIRRT; Peritoneal Dialysis; APD; RRT; RT-PCR; CRE; Renal replacement therapy; CKD; RO; SLED; AKI; CVVHDF
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.12.023

The aim of this study is to describe the incidence of Acute Kidney Injury (AKI) amongst patients admitted to the Intensive Care Unit (ICU) with COVID-19. In addition we aim to detail the range of Renal Replacement Therapy (RRT) modalities offered to these patients (including peritoneal dialysis - PD - and intermittent haemodialysis - IHD) in order to meet demand during pandemic conditions. Single-centre retrospective case note review of adult patients with confirmed COVID-19 admitted to ICU. Amongst 136 patients without a prior history of End Stage Kidney Disease (ESKD), 108 (79%) developed AKI and 63% of admitted patients received RRT. Due to resource limitations the range of RRT options were expanded from solely Continuous Veno-Venous HaemoDiaFiltration (CVVHDF - our usual standard of care) to include PD (in 35 patients) and IHD (in 15 patients). During the study period the proportion of RRT provided within ICU as CVVHDF fell from 100% to a nadir of 39%. There were no significant complications of either PD or IHD. During periods of resource limitations PD and IHD can safely be used to reduce dependence on CVVHDF in select patients with AKI secondary to COVID-19. •AKI frequently complicates COVID-19 in patients admitted to ICU.•Large numbers of patients and high rates of AKI leads to great demand for RRT.•In selected patients PD and IHD can supplement CRRT in meeting this demand.•PD and IHD can be implemented rapidly and safely through a collaborative approach.