Abstract
COVID-19 often leads to acute respiratory distress syndrome complicated by acute kidney injury (AKI). The indications for renal replacement therapy for these patients are those commonly accepted to treat AKI. We describe a continuous veno-venous haemodialysis (CVVHD) protocol for AKI, which aims to provide the best treatment according to the particular patient’s and medical personnels’ needs in biohazard settings with limited human and technological resources. We designed a CVVHD protocol with a high cut-off (HCO) filter in regional citrate anticoagulation (RCA). The HCO filter in diffusion determines the enhanced cytokines clearance with less filter clotting due to a lower filtration fraction. In our hospital, at the beginning of the pandemic outbreak, we treated seven COVID-19 patients with AKI stage 2 and 3 and recorded the circuit lifespan and the number of interventions on monitors. CVVHD in RCA appears to be safe, effective and easy to be performed in a biohazard scenario using lower blood flows and less bag changes with fluid savings, a biohazard reduction and sparing of resources. Although the data come from a very small cohort, our protocol seems related to a low mortality.
Highlights
The SARS-CoV-2 infection, termed coronavirus disease 2019 (COVID-19), appeared for the first time in Italy, among the European countries, with two simultaneous outbreaks in the Lombardy and Veneto regions
Seven patients were treated with the regional citrate anticoagulation (RCA)-high cut-off (HCO)-continuous veno-venous hemodialysis (CVVHD) protocol until now (Table 4)
Convective therapies (CVVH) are technically the most indicated modality for the removal of large molecules such as cytokine and myoglobin, the disadvantage of pre- or post-dilution on the circuit management limits their use in a biohazard setting, where the bleeding risk, the request for low effluent volumes and minimal technical interventions on the continuous renal replacement therapy (CRRT) monitors are essential for the biocontainment
Summary
The SARS-CoV-2 infection, termed coronavirus disease 2019 (COVID-19), appeared for the first time in Italy, among the European countries, with two simultaneous outbreaks in the Lombardy and Veneto regions. Our Veneto Regional Hub Hospital for COVID-19 in Padua, has firstly faced an increasing number of patients admitted to the intensive care unit (ICU) due to severe illness. Patients affected by COVID-19 present a dysfunctional immune system with an uncontrolled immune response, leading to a “cytokine storm” associated with a severe lung injury [1], as described for SARS-CoV, in which was described an increased proinflammatory cytokines level associated with pulmonary inflammation and extensive lung damage [2]. Patients affected by COVID-19 requiring ICU admission have higher levels of cytokines, suggesting that the “cytokine storm” is associated with the disease severity [3].
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