COVID-19 EMERGENCY SUPPORT

IMPACT ON AKI AND CRRT

AKI REQUIRING RRT HAS BEEN REPORTED IN 15-40% OF PATIENTS WITH COVID-19 WHO ARE ADMITTED TO THE INTENSIVE CARE UNIT.28,29,31

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CRRT IS THE PREFERRED MODALITY ACROSS PUBLISHED GUIDELINES

ASN GUIDELINES31
NIH GUIDELINES32
 
 

ASN RECOMMENDATIONS31

  • If available at an institution, the preferred modality for RRT in critically ill patients is CRRT or PIRRT.
  • CRRT machines (if available) are preferred over IHD in setting of biocontainment/isolation as IHD requires 1:1 nursing support.
  • IHD can be performed if CRRT and PIRRT equipment are not available.
  • If patient surge overwhelms CRRT capacity, consideration should be given to using CRRT machines for prolonged intermittent treatments (e.g., 10 hours vs. continuous) with higher flow rates (e.g., 40-50 ml/kg/hour), then using the machine for another patient after terminal cleaning.

NIH GUIDELINES ON ACUTE KIDNEY INJURY AND
RENAL REPLACEMENT THERAPY32

  • For critically ill patients with COVID-19 who have acute kidney injury (AKI) and who develop indications for renal replacement therapy (RRT), the COVID-19 Treatment Guidelines Panel recommends continuous renal replacement therapy (CRRT), if available.
  • If CRRT is not available or not possible due to limited resources, the Panel recommends prolonged intermittent renal replacement therapy (PIRRT) rather than intermittent hemodialysis (IHD).