Preventive strategies and renal replacement therapies for patients with COVID-19

Abstract

The current pandemic of coronavirus disease 2019 (COVID-19) spotlighted the vulnerability of patients with chronic kidney disease stage 5 on maintenance hemodialysis (HD) to the viral infection, A baseline hyperinflammatory state driven by factors such as the retention of uremic toxins afflicts these patients. Emphasis is placed on preparedness and prevention strategies for infection with this new COVID-19 Virus. Extracorporeal techniques can be helpful in the modulation of an immune dysregulated response, both in the severely ill and in the chronic HD patient. The use of high-flux (HF) dialyzers for HD is the standard of care. However, with HF membranes the effect is augmented when applied in a Hemodiafiltration mode, thanks for its dragging effect, on the other hand the use of superflux or Medium cut off dialyzers MCO are advantageous in removing the larger middle molecules with special respect to the cytokines release as a main cause of deterioration in those patients the use of more prolonged Hemodialysis, namely Continuous Renal Replacement Therapy (CRRT) as well the Prolonged Intermittent Renal Replacement Therapy (PIRRT) are considered best options as per its more prolongated time so compensate for the balance between production and elimination. Important issues are to improve the overall patients conditions on Maintenance Hemodialysis (MHD) in the term of maximizing the HD Dose, Nutritional support, treatment of any comorbidity as well inflammation as first step in preparedness of patients beside the strict and extensively adherent to preventive strategies that may improve the overall outcomes if they get infected with COVID-19.