Focus
- Provide guidance on the potential unique aspects of managing acute kidney injury (AKI) requiring renal replacement therapy (RRT) in the COVID-19 patient.
- Anticipate resource requirements and modify staffing, modality and supplies to reflect these changes.
General Considerations
- AKI is associated with increased in-hospital mortality in COVID-19 patients.
- Mild AKI is common at presentation and is usually pre-renal. Patients should be volume resuscitated to a target of euvolemia.
- Mechanisms of AKI are poorly understood and may include (but are not limited to):
- Hypovolemia and under-resuscitation early in the disease course
- We recommend adequate initial fluid resuscitation to target euvolemia
- Hemodynamic issues related to ARDS or COVID-19
- vasodilatory shock
- cardiogenic shock
- Thrombotic microangiopathy
- Rhabdomyolysis
- Hypovolemia and under-resuscitation early in the disease course
- In the presence of a large community surge, increased demand for acute RRT in critically ill COVID-19 patients may strain dialysis resources and consideration of staffing models and supplies is recommended.
Modality of RRT
- For chronic dialysis patients, we recommend continuing the patient’s baseline modality
- For AKI, hemodialysis modalities are preferred over acute peritoneal dialysis
- Choice of renal replacement modality should be institution-specific based on experience and availability:
- SLED or CRRT may be preferred for hemodynamically unstable patients
- Patients should be transitioned to IHD once hemodynamics will tolerate
Dialysis circuit clotting
- See ANTICOAGULATION
- Local experience suggests this is more frequent in COVID-19 than in others.
- Higher blood flow rates may also help reduce circuit clotting
- Saline flushes during dialysis may help reduce circuit clotting.