MO677RRT DURING COVID 19 EPIDEMIC. EXPIRIENCE OF ONE CENTER

Abstract

Background and AimsThe incidence of Acute kidney injuri AKI during Covid 19 infection is 3 – 15%, up to 50% for patients (pts) with Acute respiratory distress syndrome ARDS.MethodFrom March till December 2020. Department for hemodialysis in Novi Sad did 184 renal replacement therapy (RRT) procedures (proc) on 65 Covid 19 positive pts.ResultsThere were 73,85% men and 26,15% women (p < 0,01), with average (avs.) age of 65,8 years (SD 9,20). Most of them were admitted directly to the Intensive care unit, 64,62% (p < 0,01). The length of stay in hospital ranged from 2 - 61 days (avs. 15,86; SD 11,19). The most common comorbidities were hypertension (86,1%), diabetes (33,8%), coronary disease (30,8%) and chronic obstructive pulmonary disease (21,5%). Most common indication for RRT was acutisation of chronic kidney disease (CKD) 43,08% (p < 0,01) followed by pre-existing end stage renal disease (ESRD) 29,23% and AKI 27,69%. RRT was started 1 - 31 days after the admittance (avs. 8,51; SD 7,33). 57 intermittent hemodialysis proc (30,98%) were done on 13 pts (14,06%) who were hemodynamicly and respiratory stable. The decision to initiate CRRT was made upon the renal indications, the presence of ARDS or significant volume load. A total of 127 CRRT proc (69,02%) were done on 57 pts (87,5%). The most of them were CVVHDF (74,02%) and the rest CVVHD (25,98%). Most commonly used membrane was oXiris 47,24% (p < 0,001) followed by EMIC2 25,98%, Kit 8 17,32% and ST-150 9,45%. Most CRRT proc (89,76%) were done with heparin as an anticoagulant and 10 proc (7,87%) in 5 pts using citrate. 3 proc (2,36%) in 2 pts were done without using anticoagulant. The procedurès duration had to depend on the number of devices, the number of pts requiring CRRT and the number of available trained medical workers. The average achieved length of proc was 712 min. (11 h and 52 min.) (SD 435,07). Most patients had 1 (49,12%; p< 0,001) or 2 (30,69%) CRRT proc, up to 9 (avs. 2,23; SD 1,95). The average achieved ultrafiltration was 2716,41 ml (SD 1016,82). In 23 pts (40,35%) 26 CRRT proc (20,47%) had to be stopped earlier, because of circuit clotting (9,45%; p < 0,001), deterioration of hemodynamic instability/respiratory insufficiency (7,09%), device malfunction (2.36%) and RRT need for another pts (1,58%). ARDS has developed 42 pts (64,61%). The need for vasoactive support had 41 pts (63,08%). 51 pts (78,46%) requiring RRT died.ConclusionComparing group of pts who survived with group of those who died, greater number of pts with ESRD was in the first group. In survivor group, RRT was started earlier with greater number and shorter duration of proc. In the group of pts who died, there were more ARDS and vasoactive support need. They had a higher levels of CRP, leukocyte count and the neutrophil to lymphocyte ratio.MO677 Table 1.Characteristic of groups of pts who survived and the group of pts who diedsurvived (No 14)died (No 51)pAge 64,14 (SD 11,77) 66,27 (SD 8,45)0,45sexM10 (71,43%)38 (74,51%)0,91fF4 (28,57%)13 (25,49%)No of comorbidities2,86 (SD 0,86)2,43 (SD 1,06)0,84IndicationAKI0 (0%)18 (35,29%)0,00CKD ac2 (14,29%)26 (50,98%)ESRD12 (85,71%)7 (13,73%)Los in hospital (days) 16,83 (SD 9,29) 15,63 (SD 11,66)0,37Los before RRT (days) 2,43 (SD 1,95) 10,18 (SD 7,39)0,00Los before RRT (only CRRT) (days) 3 (SD 2,27) 10,43 (SD 7,42)0,007No of proc 4,38 (SD 3,38) 1,88 (SD 1,36)0,008Duration of proc(min.) 464,17 (SD 27,36) 744,46 (SD 456,48)0,03membranesoXiris+EMIC215 (42,86%)78 (84,78%)0,00Kit8+ST-15020 (57,14%)14 (15,22%)UF/proc (ml) 2799,06 (SD 457,88) 2702,91 (SD 1111,24)0,14AnuriaY8 (57,14%)20 (39,22%)0,37N6 (42,56%)31 (60,78%)vasoactive supportY0 (0%)41 (80,39%)0,00N14 (100%)10 (19,71%)ARDSY1 (7,14%)44 (86,27%)0,00N13 (92,86%)7 (13,73%)WBC (* 10^9/l)6,91 (SD 2,63)11,82 (SD 8,63)0,02NLR 7,48 (SD 3,92) 17,78 (SD 14,25)0,017PLR 266,41 (SD 162,52) 334,60 (SD 322,35)0,48CRP (mg/l) 114,68 (SD 141,80) 192,34 (SD 107,23)0,039PCT (ng/ml) 3,81 (SD 4,98) 12,67 (SD 26,58)0,28