Sustained low-efficiency dialysis vs. Continuous renal replacement therapy in critically ill COVID-19 Patients

ABSTRACT

Background: Acute kidney injury among patients with COVID-19 infection is a poor prognostic indicator. There is limited evidence to guide the nephrology community if there are any risk or advantages of using sustained low-efficiency dialysis (SLED) or continuous renal replacement therapy (CRRT). We aim to evaluate the clinical outcomes of COVID-19 patients receiving renal replacement therapy in the intensive care unit (ICU). Methods: This is a retrospective chart review of adult patients with COVID-19 admitted to ICU in the state of Qatar who had 1)acute kidney injury and 2)received renal replacement therapy between February to August of 2020. We evaluated clinical characteristic, severity of illness, mortality, and renal outcomes at 30 days. Results: Among 127 patients with acute kidney injury requiring dialysis in ICU, 16 patients were on CRRT, 68 patients were on SLED, and 43 patients were on combination. We did not observe significant difference among age, gender, ethnicity or baseline creatinine. Most common indication for indication of dialysis was volume overload followed by acidosis in all three groups with serum creatinine of 264umol/L vs 499umol/L vs 351umol/L in CRRT, SLED and CRRT+SLED, respectively. Inflammatory markers, Pressore requirement and APACHE II score were similar between all groups. 30-day Survival was 23%, 50% and 9%. Among 34 patients on SLED who survived, 6 were dialysis dependent post COVID-19 infection. Conclusions: Acute kidney failure in critically ill COVID-19 patients is associated with high mortality. A lower mortality, but high morbidity is observed in patients receiving SLED in critical care setting. Further investigation of SLED in COVID-19 should be considered.