1
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Sourial MY, Gone A, Uribarri J, Srivatana V, Sharma S, Shimonov D, Chang M, Mowrey W, Dalsan R, Sedaliu K, Jain S, Ross MJ, Caplin N, Chen W. Outcomes of PD for AKI treatment during COVID-19 in New York City: A multicenter study. Perit Dial Int 2023; 43:13-22. [PMID: 36320182 PMCID: PMC10115518 DOI: 10.1177/08968608221130559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy). METHODS In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan-Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery. RESULTS The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27-0.82, p = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery (p = 0.48). CONCLUSIONS The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings.
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Affiliation(s)
- Maryanne Y Sourial
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Anirudh Gone
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Jaime Uribarri
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vesh Srivatana
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
- The Rogosin Institute, New York, NY, USA
| | - Shuchita Sharma
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniil Shimonov
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
- The Rogosin Institute, New York, NY, USA
| | - Michael Chang
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rochelle Dalsan
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kaltrina Sedaliu
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Swati Jain
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Michael J Ross
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Nina Caplin
- Division of Nephrology, New York University Langone Health and New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York City Health and Hospitals/Bellevue, New York, NY, USA
| | - Wei Chen
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA
- Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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2
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Alabbas A, Kirpalani A, Morgan C, Mammen C, Licht C, Phan V, Wade A, Harvey E, Zappitelli M, Clark EG, Hiremath S, Soroka SD, Wald R, Weir MA, Chanchlani R, Lemaire M. Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Guidelines for Management of Acute Kidney Injury in Children. Can J Kidney Health Dis 2021; 8:2054358121990135. [PMID: 33614056 PMCID: PMC7868478 DOI: 10.1177/2054358121990135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This article provides guidance on managing acute kidney injury (AKI) and kidney replacement therapy (KRT) in pediatrics during the COVID-19 pandemic in the Canadian context. It is adapted from recently published rapid guidelines on the management of AKI and KRT in adults, from the Canadian Society of Nephrology (CSN). The goal is to provide the best possible care for pediatric patients with kidney disease during the pandemic and ensure the health care team's safety. INFORMATION SOURCES The Canadian Association of Paediatric Nephrologists (CAPN) COVID-19 Rapid Response team derived these rapid guidelines from the CSN consensus recommendations for adult patients with AKI. We have also consulted specific documents from other national and international agencies focused on pediatric kidney health. We identified additional information by reviewing the published academic literature relevant to pediatric AKI and KRT, including recent journal articles and preprints related to COVID-19 in children. Finally, our group also sought expert opinions from pediatric nephrologists across Canada. METHODS The leadership of the CAPN, which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric AKI and acute KRT. The goal was to adapt the guidelines recently adopted for Canadian adult patients for pediatric-specific settings. These included specific COVID-19-related themes relevant to AKI and KRT in a Canadian setting, as determined by a group of kidney disease experts and leaders. An expert group of clinicians in pediatric AKI and acute KRT reviewed the revised pediatric guidelines. KEY FINDINGS (1) Current Canadian data do not suggest an imminent threat of an increase in acute KRT needs in children because of COVID-19; however, close coordination between nephrology programs and critical care programs is crucial as the pandemic continues to evolve. (2) Pediatric centers should prepare to reallocate resources to adult centers as needed based on broader health care needs during the COVID-19 pandemic. (3) Specific suggestions pertinent to the optimal management of AKI and KRT in COVID-19 patients are provided. These suggestions include but are not limited to aspects of fluid management, KRT vascular access, and KRT modality choice. (4) Considerations to ensure adequate provision of KRT if resources become scarce during the COVID-19 pandemic. LIMITATIONS We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. The local context, including how the provision of care for AKI and acute KRT is organized, may impede the implementation of many suggestions. As knowledge is advancing rapidly in the area of COVID-19, suggestions may become outdated quickly. Finally, most of the literature for AKI and KRT in COVID-19 comes from adult data, and there are few pediatric-specific studies. IMPLICATIONS Given that most acute KRT related to COVID-19 is likely to be required in the pediatric intensive care unit initial setting, close collaboration and planning between critical care and pediatric nephrology programs are needed. Our group will update these suggestions with a supplement if necessary as newer evidence becomes available that may change or add to the recommendations provided.
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Affiliation(s)
- Abdullah Alabbas
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Amrit Kirpalani
- Department of Paediatrics, Division of Nephrology, Western University, London, ON, Canada
| | - Catherine Morgan
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Cherry Mammen
- Department of Paediatrics, Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Christoph Licht
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Veronique Phan
- Department of Paediatrics, Division of Nephrology, Université de Montréal, Québec, Canada
| | - Andrew Wade
- Department of Paediatrics, Division of Nephrology, University of Calgary, AB, Canada
| | - Elizabeth Harvey
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Michael Zappitelli
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Steven D. Soroka
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and Department of Medicine, University of Toronto, ON, Canada
| | - Matthew A. Weir
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - Mathieu Lemaire
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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3
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Soomro QH, Mukherjee V, Amerling R, Caplin N. Case series of acute peritoneal dialysis in the prone position for acute kidney injury during the Covid-19 pandemic: Prone to complications? Perit Dial Int 2021; 41:328-332. [PMID: 33410384 DOI: 10.1177/0896860820983670] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Patients with kidney failure and acute respiratory distress syndrome (ARDS) requiring prone position have not been candidates for peritoneal dialysis (PD) due to concern with increased intra-abdominal pressure, reduction in respiratory system compliance and risks of peritoneal fluid leaks. We describe our experience in delivering acute PD during the surge in Covid-19 acute kidney injury (AKI) in the subset of patients requiring prone positioning. All seven patients included in this report were admitted to the intensive care unit with SARS-CoV-2 infection leading to ARDS, AKI and multisystem organ failure. All required renal replacement therapy, and prone positioning to improve ventilation/perfusion mismatch. All seven were able to continue PD despite prone positioning without any detrimental effects on respiratory mechanics or the need to switch to a different modality. Fluid leakage was noted in 71% of patients, but mild and readily resolved. We were able to successfully implement acute PD in ventilator-dependent prone patients suffering from Covid-19-related AKI. This required a team effort and some modifications in the conventional PD prescription and delivery.
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Affiliation(s)
- Qandeel H Soomro
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Vikramjit Mukherjee
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Bellevue Hospital Center and 12297NYU Langone Health, New York, NY, USA
| | - Richard Amerling
- St. George's University School of Medicine, Grenada, West Indies
| | - Nina Caplin
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
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4
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Naljayan M, Yazdi F, Struthers S, Sharshir M, Williamson A, Simon EE. COVID-19 in New Orleans: A Nephrology Clinical and Education Perspective and Lessons Learned. Kidney Med 2021; 3:99-104. [PMID: 33283183 PMCID: PMC7708233 DOI: 10.1016/j.xkme.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
New Orleans' first case of coronavirus disease 2019 (COVID-19) was reported on March 9, 2020, with a subsequent rapid increase in the number of cases throughout the state of Louisiana. Traditional educational efforts were no longer viable with social distancing and stay-at-home orders; therefore, virtual didactics were integrated into our curriculum. Due to an exponential increase in the number of patients with acute kidney injury requiring kidney replacement therapy, the nephrology sections at Louisiana State University School of Medicine and Tulane University School of Medicine adapted their clinical workflows to accommodate these increased clinical volumes by using prolonged intermittent kidney replacement therapies and acute peritoneal dialysis, as well as other strategies to mitigate nursing burnout and decrease scarce resource use. Telehealth was implemented in outpatient clinics and dialysis units to protect vulnerable patients with kidney disease while maintaining access to care. Lessons learned from this pandemic and subsequent response may be used for future responses in similar situations.
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Affiliation(s)
- Mihran Naljayan
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Farshid Yazdi
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Sarah Struthers
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Moh’d Sharshir
- Section of Nephrology and Hypertension, Tulane School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, LA
| | | | - Eric E. Simon
- Section of Nephrology and Hypertension, Tulane School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, LA
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5
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Caplin NJ, Zhdanova O, Tandon M, Thompson N, Patel D, Soomro Q, Ranjeeta F, Joseph L, Scherer J, Joshi S, Dyal B, Chawla H, Iyer S, Bails D, Benstein J, Goldfarb DS, Gelb B, Amerling R, Charytan DM. Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City. KIDNEY360 2020; 1:1345-1352. [PMID: 35372895 DOI: 10.34067/kid.0005192020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI. Methods Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive-care unit, demonstrating efficacy with outcomes comparable to standard care. Results From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.
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Affiliation(s)
- Nina J Caplin
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Olga Zhdanova
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Manish Tandon
- Department of Surgery, NYU Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Surgery, New York City Health and Hospitals/Bellevue, New York, New York
| | - Nathan Thompson
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Dhwanil Patel
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Qandeel Soomro
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Fnu Ranjeeta
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Leian Joseph
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Jennifer Scherer
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Shivam Joshi
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Betty Dyal
- Lower Manhattan Dialysis Center, Inc., New York, New York
| | - Harminder Chawla
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York.,Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York
| | - Sitalakshmi Iyer
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Douglas Bails
- Department of Medicine, New York City Health and Hospitals/Bellevue, New York, New York.,Department of Medicine, NYU Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Judith Benstein
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - David S Goldfarb
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Bruce Gelb
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Richard Amerling
- St. George's University School of Medicine, True Blue Campus, St. Georges, Grenada
| | - David M Charytan
- Division of Nephrology, New York University Langone Health and NYU Grossman School of Medicine, New York, New York
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6
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Bowes E, Joslin J, Braide-Azikiwe DCB, Tulley C, Bramham K, Saha S, Jayawardene S, Shakoane B, Wilkins CJ, Hutchings S, Hopkins P, Lioudaki E, Shaw C, Cairns H, Sharpe CC. Acute Peritoneal Dialysis With Percutaneous Catheter Insertion for COVID-19-Associated Acute Kidney Injury in Intensive Care: Experience From a UK Tertiary Center. Kidney Int Rep 2020; 6:265-271. [PMID: 33521400 PMCID: PMC7836882 DOI: 10.1016/j.ekir.2020.11.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction During the coronavirus disease 2019 (COVID-19) pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to an increased demand for renal replacement therapy (RRT). Providing RRT for this large number of patients is proving challenging, and so alternatives to continuous renal replacement therapies (CRRT) in the intensive care unit (ICU) are needed. Peritoneal dialysis (PD) can be initiated immediately after percutaneous insertion of the catheter, but there are concerns about impact on ventilation and RRT efficacy. We sought to describe our recent experience with percutaneous catheter insertion and peritoneal dialysis in patients in the ICU with COVID-19 infection. Method Patients were selected according to local protocol, and catheters were inserted percutaneously by experienced operators using a Seldinger technique. Sequential Organ Failure Assessment (SOFA) score and ventilation requirements were recorded at the time of insertion and 24 hours later. Procedural complications, proportion of RRT provided by PD, renal recovery, and RRT parameters (serum potassium and maximum base excess) during PD were assessed. Results Percutaneous PD catheters were successfully inserted in 37 of 44 patients (84.1%) after a median of 13.5 days (interquartile range [IQR] = 10.0, 20.3 days) in the ICU. No adverse events were reported; SOFA scores and ventilation requirements were comparable before and after insertion; and adequate RRT parameters were achieved. The median proportion of RRT provided by PD following catheter insertion was 94.6% (IQR = 75.0, 100%). Conclusion Peritoneal dialysis provides a safe and effective alternative to CRRT in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.
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Affiliation(s)
- Elaine Bowes
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Jennifer Joslin
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | | | - Caroline Tulley
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Sujit Saha
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Satish Jayawardene
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Babakang Shakoane
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - C Jason Wilkins
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sam Hutchings
- Faculty of Life Sciences and Medicine, King's College London, UK.,Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Philip Hopkins
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Eirini Lioudaki
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Catriona Shaw
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Hugh Cairns
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Claire C Sharpe
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
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7
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Shimonov D, Srivatana V. Peritoneal Dialysis for Acute Kidney Injury during the COVID-19 Pandemic. Clin J Am Soc Nephrol 2020; 15:1829-1831. [PMID: 32801119 PMCID: PMC7769024 DOI: 10.2215/cjn.09240620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Daniil Shimonov
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Vesh Srivatana
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
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8
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McAdams M, Ostrosky-Frid M, Rajora N, Hedayati S. Effect of COVID-19 on Kidney Disease Incidence and Management. KIDNEY360 2020; 2:141-153. [PMID: 35368812 PMCID: PMC8785734 DOI: 10.34067/kid.0006362020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 02/04/2023]
Abstract
The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus's effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.
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Affiliation(s)
- Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nilum Rajora
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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9
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Rodríguez-Chagolla JM, Vásquez Jiménez E, Herrera Arellano L, Villa Torres A, Acosta García N, Aleman Quimbiulco D, Armeaga Aguilar S, Madero M. Peritoneal Dialysis Is an Option for Acute Kidney Injury Management in Patients with COVID-19. Blood Purif 2020; 50:283-289. [PMID: 33017826 PMCID: PMC7573901 DOI: 10.1159/000511390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022]
Abstract
In December 2019, cases of acute respiratory illness of unknown origin were reported in Wuhan, China. The disease is caused by "severe acute respiratory syndrome coronavirus 2". After identifying severe lung damage, injury to other organs, such as the kidney, has been identified. Peritoneal dialysis is a renal replacement therapy (RRT) and is at least as effective as other extracorporeal therapy options, with significant cost-effective advantages. However, this strategy is rarely used for the management of acute kidney injury in severe lung disease. In this review, we explore PD as an RRT strategy that may be a key instrument in countries and hospitals with limited access to all RRTs.
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Affiliation(s)
| | - Enzo Vásquez Jiménez
- Nephrology Department, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | | | | | | | | | - Magdalena Madero
- Nephrology Department, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
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10
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Abstract
Coronavirus disease-2019 (COVID-19) has caused a pandemic that has affected millions of people worldwide. COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and is spread by close contact and by respiratory droplets. It has also impacted different aspects of caring for people with kidney disease, including those with acute kidney injury (AKI), chronic kidney disease (CKD), those requiring kidney replacement therapy (KRT), and those with a kidney transplant. All of these patients are considered high risk. The lessons learned from the COVID-19 pandemic will hopefully serve to protect patients with kidney disease in a similar situation in the future.
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11
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Shaikh S, Matzumura Umemoto G, Vijayan A. Management of Acute Kidney Injury in Coronavirus Disease 2019. Adv Chronic Kidney Dis 2020; 27:377-382. [PMID: 33308502 PMCID: PMC7409928 DOI: 10.1053/j.ackd.2020.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/17/2023]
Abstract
Acute kidney injury is a common complication in hospitalized patients with coronavirus disease 2019. Similar to acute kidney injury associated with other conditions such as sepsis and cardiac surgery, morbidity and mortality are much higher in patients with coronavirus disease 2019 who develop acute kidney injury, especially in the intensive care unit. Management of coronavirus disease 2019-associated acute kidney injury with kidney replacement therapy should follow existing recommendations regarding modality, dose, and timing of initiation. However, patients with coronavirus disease 2019 are very hypercoagulable, and close vigilance to anticoagulation strategies is necessary to prevent circuit clotting. During situations of acute surge, where demand for kidney replacement therapy outweighs supplies, conservative measures have to be implemented to safely delay kidney replacement therapy. A collaborative effort and careful planning is needed to conserve dialysis supplies, to ensure that treatment can be safely delivered to every patient who will benefit for kidney replacement therapy.
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Affiliation(s)
- Sana Shaikh
- Division of Nephrology, Washington University in St. Louis, St. Louis, MO
| | | | - Anitha Vijayan
- Division of Nephrology, Washington University in St. Louis, St. Louis, MO.
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Clark EG, Hiremath S, Soroka SD, Wald R, Weir MA. CSN COVID-19 Rapid Review Program: Management of Acute Kidney Injury. Can J Kidney Health Dis 2020; 7:2054358120941679. [PMID: 32728473 PMCID: PMC7364799 DOI: 10.1177/2054358120941679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Severe acute kidney injury (AKI) is a potential complication of COVID-19-associated critical illness. This has implications for the management of COVID-19-associated AKI and the resulting increased need for kidney replacement therapy (KRT) in the intensive care unit (ICU) and elsewhere in the hospital. The Canadian Society of Nephrology COVID-19 Rapid Review Team has sought to collate and synthesize currently available resources to inform ethically justifiable decisions. The goal is the provision of the best possible care for the largest number of patients with kidney disease while considering how best to ensure the safety of the health care team. INFORMATION SOURCES Local, provincial, national, and international guidance and planning documents related to the COVID-19 pandemic; guidance documents available from nephrology and critical care-related professional organizations; recent journal articles and preprints related to the COVID-19 pandemic; expert opinion from nephrologists from across Canada. METHODS A working group of kidney specialist physicians was established with representation from across Canada. Kidney physician specialists met via teleconference and exchanged e-mails to refine and agree on the proposed suggestions in this document. KEY FINDINGS (1) Nephrology programs should work with ICU programs to plan for the possibility that up to 30% or more of critically ill patients with COVID-19 admitted to ICU will require kidney replacement therapy (KRT). (2) Specific suggestions pertinent to the optimal management of AKI and KRT in patients with COVID-19. These suggestions include, but are not limited to, aspects of fluid management, KRT vascular access, and KRT modality choice. (3) We describe considerations related to ensuring adequate provision of KRT, should resources become scarce during the COVID-19 pandemic. LIMITATIONS A systematic review or meta-analysis was not conducted. Our suggestions have not been specifically evaluated in the clinical environment. The local context, including how the provision of acute KRT is organized, may impede the implementation of many suggestions. Knowledge is advancing rapidly in the area of COVID-19 and suggestions may become outdated quickly. IMPLICATIONS Given that most acute KRT related to COVID-19 is likely to be required initially in the ICU setting, close collaboration and planning between critical care and nephrology programs is required. Suggestions may be updated as newer evidence becomes available.
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Affiliation(s)
- Edward G. Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Steven D. Soroka
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and Department of Medicine, University of Toronto, ON, Canada
| | - Matthew A. Weir
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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13
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Ponce D, Balbi AL, Durand JB, Moretta G, Divino-Filho JC. Acute peritoneal dialysis in the treatment of COVID-19-related acute kidney injury. Clin Kidney J 2020; 13:269-273. [PMID: 32695319 PMCID: PMC7337686 DOI: 10.1093/ckj/sfaa102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 01/20/2023] Open
Abstract
The kidney is not typically the main target of severe acute respiratory syndrome coronavirus 2, but surprisingly, acute kidney injury (AKI) may occur in 4-23% of cases, whereas the dialysis management of AKI from coronavirus 2019 has not gained much attention. The severity of the pandemic has resulted in significant shortages in medical supplies, including respirators, ventilators and personal protective equipment. Peritoneal dialysis (PD) remains available and has been used in clinical practice for AKI for >70 years; however, it has been used on only a limited basis and therefore experience and knowledge of its use has gradually vanished, leaving a considerable gap. The turning point came in 2007, with a series of sequential publications providing solid evidence that PD is a viable option. As there was an availability constraint and a capacity limit of equipment/supplies in many countries, hemodialysis and convective therapies became alternatives. However, even these therapies are not available in many countries and their capacity is being pushed to the limit in many cities. Evidence-based PD experience lends support for the use of PD now.
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Affiliation(s)
- Daniela Ponce
- Internal Medicine Department, University of Sao Paulo State, UNESP, Botucatu, São Paulo, Brazil
| | - André L Balbi
- Internal Medicine Department, University of Sao Paulo State, UNESP, Botucatu, São Paulo, Brazil
| | - Jonathan B Durand
- Nephrology Department, Universidad Cientifica del Sur s.a.c, Clínica Ricardo Palma, Lima, Peru
| | - Gustavo Moretta
- Nephrology Department, Universidad Nacional Del Noroeste de Buenos Aires, Buenos Aires, Argentina
| | - José C Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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Gallieni M, Sabiu G, Scorza D. Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy. KIDNEY360 2020; 1:403-409. [PMID: 35369371 PMCID: PMC8809285 DOI: 10.34067/kid.0001782020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Maurizio Gallieni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, Milan, Italy
- Specialty School of Nephrology, Università degli Studi di Milano, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Gianmarco Sabiu
- Specialty School of Nephrology, Università degli Studi di Milano, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Daniele Scorza
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
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Srivatana V, Aggarwal V, Finkelstein FO, Naljayan M, Crabtree JH, Perl J. Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 1:410-415. [DOI: 10.34067/kid.0002152020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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