Abstract
Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity.
Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection.
Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak.
Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 24 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented.
Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.
References
Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol. 2020;16(6):308-10- http://dx.doi.org/10.1038/s41581-020-0284-7
Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J Am Soc Nephrol. 2020;31(6):1157-65. http://dx.doi.org/10.1681/ASN.2020030276
Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int. 2020;97(5):824-8. https://doi.org/10.1016/j.kint.2020.03.001
Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368(6490):473-4. http://dx.doi.org/10.1126/science.abb8925
Husain-Syed F, Slutsky AS, Ronco C. Lung-Kidney Cross-Talk in the Critically Ill Patient. Am J Respir Crit Care Med. 2016;194(4):402-14. http://dx.doi.org/10.1164/rccm.201602-0420CP
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. http://dx.doi.org/10.1016/S0140-6736(20)30937-5.
Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 202;98(1):219-27. https://doi.org/10.1016/j.kint.2020.04.003.
Larsen CP, Bourne TD, Wilson JD, Saqqa O, Sharshir MA. Collapsing Glomerulopathy in a Patient With COVID-19. Kidney Int Rep. 2020;5(6):935-9: https://doi.org/10.1016/j.ekir.2020.04.002
Delvaeye M, Conway EM. Coagulation and innate immune responses: can we view them separately? Blood. 2009;114(12):2367-74. https://doi.org/10.1182/blood-2009-05-199208.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. https://doi.org/10.1111/jth.14768.
. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. http://dx.doi.org/10.1016/S0140-6736(20)30566-3
Diao B, Wang C, Feng Z, Tan Y, Wang H, Wang C, Liu L, et al. Human Kidney is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection. medRxiv. 2020. https://doi.org/10.1101/2020.03.04.20031120
Li Z, Wu M, Yao J, Guo J, Liao X, Song S, et al. Caution on Kidney Dysfunctions of COVID-19 Patients. medRxiv. 2020. https://doi.org/10.1101/2020.02.08.20021212
Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology. J Am Soc Nephrol]. 2020;31(7):1380-3. http://dx.doi.org/10.1681/ASN.2020040419.
Faubel S, Edelstein CL. Mechanisms and mediators of lung injury after acute kidney injury. Nat Rev Nephrol. 2016;12(1):48-60. http://dx.doi.org/10.1038/nrneph.2015.158
Alles A, Cueto-Manzano A, Ríos P, Robayo A, Sánchez-Polo V, Silvariño R, et al. Recomendaciones para el manejo de pacientes portadores de enfermedad renal frente a la epidemia de coronavirus (COVID-19). Ciudad de Panamá: Sociedad Latinoamericana de Nefrología e Hipertensión; 2020.
Ronco C, Reis T, Husain-syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8(70):738-42. http://dx.doi.org/10.1016/S2213-2600(20)30229-0
Joannidis M, Forni LG, Klein SJ, Honore PM, Kashani K, Ostermann M, et al. Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup. Intensive Care Med. 2020;46(4):654-72. http:// dx.doi.org/10.1007/s00134-019-05869-7
Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. http://dx.doi.org/10.1016/j.kint.2020.03.005
BRIGHAM AND WOMEN HOSPITAL. Nephrology. Acute Kidney Injury. 2020.
Yang Y, Shi J, Ge S, Guo S, Xing X, Wang Y, et al. Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a retrospective cohort study. medRxiv. 2020. https://doi.org/10.1101/2020.03.16.20036780
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. https:// doi.org/10.1001/jama.2020.6775
Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-18. https://doi.org/10.1016/j.kint.2020.05.006
Burgner A, Ikizler TA, Dwyer JP. COVID-19 and the Inpatient Dialysis Unit: Managing Resources During Contingency Planning Pre- Crisis. CJASN. 2020;15(5):720-2. https://doi.org/10.2215/CJN.03750320
Acute RRT For Critically Ill Patients in ICU Settings During Respiratory Pandemic (SARS-CoV-2 [COVID-19], Pandemic Influenza, others). Emory Healthcare; 2020.
Yang X, Sun R, Dechang C. 新型冠状病毒肺炎诊治:急性肾损伤不容忽视.. Chin Med J (Engl). 2020; 27. Goldfarb DS, Benstein JA, Zhdanova O, Hammer E, Block CA, Caplin NJ, et al. Impending Shortages of Kidney Replacement Therapy for COVID-19 Patients. Clin J Am Soc Nephrol. 2020;15(6):880-2. https://doi.org/10.2215/CJN.05180420.
Molina-Andújar A, Blasco M, Poch E. Papel de la diálisis sostenida de baja eficiencia en las unidades de cuidados intensivos. Nefrología. 2009;39(1):1-3. http://dx.doi.org/10.1016/j.nefro.2018.06.002
Palevsky PM, Radhakrishnan J, Townsend RR, Bakris GL, Forman JP. END-STAGE KIDNEY DISEASE. 2020;2019:1-18.
Aggarwal S, Garcia-Telles N, Aggarwal G, Lavie C, Lippi G, Henry BM. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis (Berlin). 2020;7(2):91-6. http://dx.doi.org/10.1515/dx-2020-0046
England. National Health Service (NHS). Clinical guide for acute kidney injury in hospitalised patients with COVID-19 outside the intensive care unit during the coronavirus pandemic. London: NHS; 2020.
Gebistorf F, Karam O, Wetterslev J, Afshari A. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults. Cochrane Database Syst Rev. 2016;2016(6):CD002787. https://doi.org/10.1002/14651858.CD002787.pub3.
Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of Patients on Dialysis and With Kidney Transplantation During the SARS-CoV-2 (COVID-19) Pandemic in Brescia, Italy. Kidney Int Reports. 2020;5(5):580-5. http:// dx.doi.org/10.1016/j.ekir.2020.04.001
Vijayan A. Advice for Managing Acute Kidney Injury in COVID-19 Patients. Medscape. 2020.
Berhés M, Fábián Á, László I, Végh T, Molnár C, Fülesdi B, et al. Emelt szint? szervtámogató és életfenntartó kezelések kritikus állapotú COVID-19-fert?zött betegeken. Orvosi Hetilap. 2020;161(17):704-9. http://dx.doi.org/10.1556/650.2020.31813
Chinese Medical Association. Expert consensus on the Application of Special Blood purification Technology in severe COVID-19 pneumonia. Chongqing; 2020.
Durvasula R, Wellington T, McNamara E, Watnick S. COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience From Seattle. Am J Kidney Dis. 2020;76(1):4-6. http://dx.doi.org/10.1053/j.ajkd.2020.04.001
Kielstein JT, Golper TA. Prolonged intermittent renal replacement therapy. UptoDate. 2020 [citado Ago 7 2020]; Disponible en: https://www.uptodate.com/contents/prolonged-intermittent-renal-replacement-therapy.
Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of Patients on Dialysis and With Kidney Transplant During Covid- 19 Coronavirus Infection. Brescia Renal Covid Task Force; 2020 [citado 2020 Ago 5]. Disponible en: https://www.era-edta.org/en/wp-content/uploads/2020/03/COVID_guidelines_finale_eng-GB.pdf.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm’’ in COVID-19. J Infect. 2020;80(6):607-13. https://doi.org/10.1016/j.jinf.2020.03.037
Fanelli V, Fiorentino M, Cantaluppi V, Gesualdo L, Stallone G, Ronco C, et al. Acute kidney injury in SARS-CoV-2 infected patients. Crit Care.2020;24(1):155. https://doi.org/10.1186/s13054-020-02872-z
Yang XH, Sun RH, Zhao MY, Chen EZ, Liu J, Wang HL, et al. Expert recommendations on blood purification treatment protocol for patients with severe COVID-19: Recommendation and consensus. Chronic Dis Transl Med. 2020;6(2):106-14. https://doi.org/10.1016/ j.cdtm.2020.04.002
Ye Q, Wang B, Mao J. Cytokine Storm in COVID-19 and Treatment. J Infect. 2020 Apr 1;
Ronco C, Reis T, De Rosa S. Coronavirus Epidemic and Extracorporeal Therapies in Intensive Care: Si vis pacem para bellum. Blood Purif. 2020;49(3):255-8. https://doi.org/10.1159/000507039
Ikizler TA, Kliger AS. Minimizing the risk of COVID-19 among patients on dialysis. Nat Rev Nephrol. 2020;16(6):311-3. http://dx.doi.org/10.1038/s41581-020-0280-y
Adams E, Mousa AY. Achieving a Popliteal Venous Access for RRT in Critically Ill COVID-19 Patient in Prone position. J Vasc Surg Cases Innov Tech. 2020;6(2):266-8. https://doi.org/10.1016/j.jvscit.2020.04.003