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Article ; Online: Continuous renal replacement therapy and the COVID pandemic.

Stevens, Jacob S / Velez, Juan Carlos Q / Mohan, Sumit

2021 Volume 34, Issue 6, Page(s) 561–566

Abstract: ... to ischemic acute kidney injury (AKI). The need for renal replacement therapies (RRTs) in those with the most ... Severe COVID-19 illness and the consequent cytokine storm and vasodilatory shock commonly lead ... in situations such as the COVID-19 pandemic, which dramatically increase demand for nephrology services. Taking ...

Abstract	Severe COVID-19 illness and the consequent cytokine storm and vasodilatory shock commonly lead to ischemic acute kidney injury (AKI). The need for renal replacement therapies (RRTs) in those with the most severe forms of AKI is considerable and risks overwhelming health-care systems at the peak of a surge. We detail the challenges and considerations involved in the preparation of a disaster response plan in situations such as the COVID-19 pandemic, which dramatically increase demand for nephrology services. Taking careful inventory of all aspects of an RRT program (personnel, consumables, and machines) before a surge in RRT arises and developing disaster contingency protocol anticoagulation and for shared RRT models when absolutely necessary are paramount to a successful response to such a disaster.
MeSH term(s)	Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; COVID-19 ; Continuous Renal Replacement Therapy ; Humans ; Pandemics ; Renal Dialysis ; Renal Replacement Therapy ; SARS-CoV-2
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.12962
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Zs.A 2879: Show issues

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Article ; Online: Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy.

Starr, Michelle C / Altemose, Kathleen / Parsley, Jessalynn / Cater, Daniel T / Hains, David S / Soranno, Danielle E

Pediatric nephrology (Berlin, Germany)

2023 Volume 39, Issue 1, Page(s) 325–329

Abstract: Background: During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT ... characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider ... therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend ...

Abstract	Background: During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT) initiations were transitioned to telemedicine to improve the timeliness of initiation, and minimize COVID-19 transmission. While telemedicine would appear acceptable for many clinical settings, safety and timeliness of telemedicine CKRT initiation is undescribed. Methods: We conducted a single-center retrospective cohort study of pediatric patients on CKRT from January 2021-September 2022. Information on patient characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider attitudes and perspectives were assessed using survey. Results: During the study period, there were 101 CKRT circuit initiations in patients not previously receiving CKRT, with 33% (33/101) initiated by telemedicine. There were no differences in patient characteristics, including age, weight at initiation, severity of illness, nor degree of fluid overload between the in-person and telemedicine initiation cohorts. CKRT telemedicine initiations were timelier, occurring on average 3.0 h after decision to initiate therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend in-person starts (p < 0.001). Complications did not differ between telemedicine and in-person starts (15% vs. 15%, p = 0.99) and initial circuit life was similar. There were no differences in likelihood of death or duration of CKRT therapy. Telemedicine initiations were widely acceptable to multidisciplinary providers. Conclusion: In appropriately selected patients, telemedicine initiation of CKRT is a timely and safe option. Further standardization of telemedicine initiation of CKRT should be considered to improve the timely delivery of CKRT and may improve nephrology workforce wellness. A higher resolution version of the Graphical abstract is available as Supplementary information.
MeSH term(s)	Humans ; Child ; Pandemics ; Retrospective Studies ; Cognition ; COVID-19/epidemiology ; Continuous Renal Replacement Therapy ; Telemedicine ; Acute Kidney Injury ; Renal Replacement Therapy
Language	English
Publishing date	2023-06-13
Publishing country	Germany
Document type	Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-023-06036-3
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Zs.A 2196: Show issues

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Article ; Online: Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy.

Choi, Dae-Eun / Kim, Duk Ki / Park, Sunghoon / Lee, Su Hwan / Park, Onyu / Kim, Taehwa / Yeo, Hye Ju / Jang, Jin Ho / Cho, Woo Hyun / Lee, Song I

PloS one

2024 Volume 19, Issue 4, Page(s) e0297344

Abstract: ... renal replacement therapy (CRRT). This study investigated the characteristics and prognoses of these patients.: Methods ... associated with higher ICU and in-hospital mortality rates in patients with COVID-19 who require MV. Notably ... healthcare, particularly in the management of patients requiring mechanical ventilation (MV) and continuous ...

Abstract	Background: The coronavirus disease (COVID-19) pandemic has significantly strained global healthcare, particularly in the management of patients requiring mechanical ventilation (MV) and continuous renal replacement therapy (CRRT). This study investigated the characteristics and prognoses of these patients. Methods: This multicenter retrospective cohort study gathered data from patients with COVID-19 across 26 medical centers. Logistic analysis was used to identify the factors associated with CRRT implementation. Results: Of the 640 patients with COVID-19 who required MV, 123 (19.2%) underwent CRRT. Compared to the non-CRRT group, the CRRT group was older and exhibited higher sequential organ failure assessment scores. The incidence of hypertension, diabetes, cardiovascular disease, chronic neurological disease, and chronic kidney disease was also higher in the CRRT group. Moreover, the CRRT group had higher intensive care unit (ICU) (75.6% vs. 26.9%, p < 0.001) and in-hospital (79.7% vs. 29.6%, p < 0.001) mortality rates. CRRT implementation was identified as an independent risk factor for both ICU mortality (hazard ratio [HR]:1.833, 95% confidence interval [CI]:1.342-2.505, p < 0.001) and in-hospital mortality (HR: 2.228, 95% CI: 1.648-3.014, p < 0.001). Refractory respiratory failure (n = 99, 19.1%) was the most common cause of death in the non-CRRT death group, and shock with multi-organ failure (n = 50, 40.7%) was the most common cause of death in the CRRT death group. Shock with multi-organ failure and cardiac death were significantly more common in the CRRT death group, compared to non-CRRT death group. Conclusion: This study indicates that CRRT is associated with higher ICU and in-hospital mortality rates in patients with COVID-19 who require MV. Notably, the primary cause of death in the CRRT group was shock with multi-organ failure, emphasizing the severe clinical course for these patients, while refractory respiratory failure was most common in non-CRRT patients.
MeSH term(s)	Humans ; Continuous Renal Replacement Therapy ; Retrospective Studies ; Coronavirus ; Respiration, Artificial ; COVID-19/therapy ; COVID-19/complications ; Prognosis ; Intensive Care Units ; Multiple Organ Failure/complications ; Coronavirus Infections/complications ; Respiratory Insufficiency/therapy ; Respiratory Insufficiency/complications ; Acute Kidney Injury ; Renal Replacement Therapy
Language	English
Publishing date	2024-04-03
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0297344
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Article: Continuous Renal Replacement Therapy: What Have We Learned And What Are Key Milestones For The Years To Come?

Galindo, Pablo / Neyra, Javier A

Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion

2023 Volume 75, Issue 6, Page(s) 348–358

Abstract: Unassigned: Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support ... particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ... therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 ...

Abstract	Unassigned: Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 years ago, there have been major improvements in its technology and utilization. The last decade, and particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ICUs. This has underpinned the need for improvements in nomenclature and process standardization, optimization of CRRT deliverables, and the development and validation of key performance indicators. Further, how to leverage digital health technologies to build clinical decision support for CRRT and improve personalized bedside decisions is a subject of intense investigation. Herein, we summarize notable advancements in the provision of CRRT and propose areas in need of further development. (Rev Invest Clin. 2023;75(6):348-58).
MeSH term(s)	Humans ; Continuous Renal Replacement Therapy ; Renal Replacement Therapy ; Acute Kidney Injury/therapy ; Pandemics ; Critical Illness/therapy ; Intensive Care Units
Language	English
Publishing date	2023-11-21
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	138348-6
ISSN	0034-8376
ISSN	0034-8376
DOI	10.24875/RIC.23000221
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Article ; Online: The Clearance of Midazolam and Metabolites during Continuous Renal Replacement Therapy in Critically Ill Patients with COVID-19.

Smeets, Tim J L / de Geus, Hilde R H / Valkenburg, Abraham J / Baidjoe, Lauren / Gommers, Diederik A M P J / Koch, Birgit C P / Hunfeld, Nicole G M / Endeman, Henrik

Blood purification

2023 Volume 53, Issue 2, Page(s) 107–113

Abstract: ... ICU patients with COVID-19 and continuous renal replacement therapy (CRRT) were at risk of unintended ... a personalized titration of midazolam in critically ill patients with renal failure and awareness ... on continuous venovenous hemodialysis (CVVHD) and 2 patients on continuous venovenous hemodiafiltration (CVVHDF ...

Abstract	Introduction: Midazolam-based continuous intravenous sedation in patients admitted to the intensive care unit (ICU) was a necessity during the COVID-19 pandemic. However, benzodiazepine-based sedation is associated with a high incidence of benzodiazepine-related delirium and additional days on mechanical ventilation. Due to the requirement of high midazolam doses in combination with the impaired renal clearance (CL) of the pharmacological active metabolite 1-OH-midazolam-glucuronide (10% compared to midazolam), ICU patients with COVID-19 and continuous renal replacement therapy (CRRT) were at risk of unintended prolonged sedation. Several CRRT-related factors may have influenced the delivered CL of midazolam and its metabolites. Therefore, the aim of the study was to identify and describe these CRRT-related factors. Methods: Pre-filter blood samples and ultrafiltrate samples were collected simultaneously. Midazolam, 1-OH-midazolam, and 1-OH-midazolam-glucuronide plasma samples were analyzed using an UPLC-MS/MS method. The prescribed CRRT dose was corrected for downtime and filter integrity using the urea ratio (urea concentration in effluent/urea concentration plasma). CL of midazolam and its metabolites were calculated with the delivered CRRT dose (corrected for downtime and saturation coefficient [SD]). Results: Three patients on continuous venovenous hemodialysis (CVVHD) and 2 patients on continuous venovenous hemodiafiltration (CVVHDF) were included. Midazolam, 1-OH-midazolam, and 1-OH-midazolam-glucuronide concentrations were 2,849 (0-6,700) μg/L, 153 (0-295) μg/L, and 27,297 (1,727-39,000) μg/L, respectively. The SD was 0.03 (0.02-0.03) for midazolam, 0.05 (0.05-0.06) for 1-OH-midazolam, and 0.33 (0.23-0.43) for 1-OH-midazolam-glucuronide. The delivered CRRT CL was 1.4 (0-1.7) mL/min for midazolam, 2.7 (0-3.5) mL/min for 1-OH-midazolam, and 15.7 (4.0-27.7) mL/min for 1-OH-midazolam-glucuronide. Conclusions: Midazolam and 1-OH-midazolam were not removed during CVVHD and CVVHDF. However, 1-OH-midazolam-glucuronide was removed reasonably, approximately up to 43%. CRRT modality, filter integrity, and downtime affect this removal. These data imply a personalized titration of midazolam in critically ill patients with renal failure and awareness for the additional sedative effects of its active metabolites.
MeSH term(s)	Humans ; Continuous Renal Replacement Therapy ; Midazolam/therapeutic use ; Critical Illness/therapy ; Chromatography, Liquid ; Glucuronides ; Pandemics ; COVID-19/therapy ; Tandem Mass Spectrometry ; Urea ; Renal Replacement Therapy ; Acute Kidney Injury
Chemical Substances	Midazolam (R60L0SM5BC) ; Glucuronides ; Urea (8W8T17847W)
Language	English
Publishing date	2023-11-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000534538
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Zs.A 1872: Show issues

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Article: Haemoadsorption Combined with Continuous Renal Replacement Therapy in Abdominal Sepsis: Case Report Series.

Sánchez-Morán, Fernando / Mateu-Campos, María Lidón / Bernal-Julián, Francisco / Gil-Santana, Ali / Sánchez-Herrero, Ángeles / Martínez-Gaspar, Teresa

Journal of personalized medicine

2023 Volume 13, Issue 7

Abstract: ... as an adjuvant therapy in septic patients. The development of new devices and the recent COVID-19 pandemic has ... the therapy, the ideal time of initiation and discontinuation, its potential side effects, and the interaction ... renewed interest in this therapy. The aim of this report is to describe our experience in patients ...

Abstract	In recent decades, multiple efforts have been made to identify targets and therapeutic measures in the host response to infection. Haemoadsorption, under the attractive theoretical premise of inflammatory response modulation through the adsorption of soluble inflammatory mediators, could have a place as an adjuvant therapy in septic patients. The development of new devices and the recent COVID-19 pandemic has renewed interest in this therapy. The aim of this report is to describe our experience in patients with abdominal sepsis for whom haemoadsorption with a neutral microporous resin column was added to conventional treatment and to describe its performance through patient cases in the absence of large randomised trials with this device. We present five patients with abdominal sepsis admitted to a Spanish intensive care unit in which haemoadsorption was used as adjuvant treatment. The key practical aspects of the treatment protocol have been used as a guide for conducting a multicentric study. Based on the experience gathered in these five cases, the potential benefit of haemoadsorption as adjuvant therapy in patients with abdominal sepsis with multiple organ failure after control of the source of infection and adequate treatment should be investigated. Likewise, it must be defined which patients can benefit from the therapy, the most appropriate biomarkers to guide the therapy, the ideal time of initiation and discontinuation, its potential side effects, and the interaction with other therapies, especially how such treatment affects the antibiotics levels.
Language	English
Publishing date	2023-07-10
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm13071113
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Article ; Online: Continuous extracorporeal treatments in a dialysis patient with COVID-19.

Nihei, Yoshihito / Nagasawa, Hajime / Fukao, Yusuke / Kihara, Masao / Ueda, Seiji / Gohda, Tomohito / Suzuki, Yusuke

CEN case reports

2020 Volume 10, Issue 2, Page(s) 172–177

Abstract: ... peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches ... including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous ... The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill patients with COVID-19.
MeSH term(s)	Aged ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/therapy ; Continuous Renal Replacement Therapy ; Fatal Outcome ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Male ; Renal Dialysis
Keywords	covid19
Language	English
Publishing date	2020-10-04
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	2660492-9
ISSN	2192-4449 ; 2192-4449
ISSN (online)	2192-4449
ISSN	2192-4449
DOI	10.1007/s13730-020-00538-x
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Article ; Online: Continuous Glucose Monitoring in the Intensive Care Unit During the COVID-19 Pandemic.

Agarwal, Shivani / Mathew, Justin / Davis, Georgia M / Shephardson, Alethea / Levine, Ann / Louard, Rita / Urrutia, Agustina / Perez-Guzman, Citlalli / Umpierrez, Guillermo E / Peng, Limin / Pasquel, Francisco J

Diabetes care

2020 Volume 44, Issue 3, Page(s) 847–849

Abstract: ... intubated, 4 on high-dose glucocorticoids, 6 on renal replacement therapy, and 2 with anasarca. Accuracy was ... disease 2019 (COVID-19) infection and glycemic variability. We analyzed inpatient CGM accuracy using point ... holds promise; however, real-world data are needed.: Research design and methods: We placed Dexcom G6 ...

Abstract	Objective: Real-time continuous glucose monitoring (rtCGM) in critically ill hospitalized patients holds promise; however, real-world data are needed. Research design and methods: We placed Dexcom G6 CGM on intensive care unit (ICU) patients at Montefiore Medical Center with confirmed coronavirus disease 2019 (COVID-19) infection and glycemic variability. We analyzed inpatient CGM accuracy using point-of-care (POC) glucose-CGM matched pairs and included patients for analysis regardless of clinical status. Results: We included 11 patients with CGM: 8 on continuous insulin infusion (CII), 8 on vasopressors, 8 intubated, 4 on high-dose glucocorticoids, 6 on renal replacement therapy, and 2 with anasarca. Accuracy was 12.58% for mean and 6.3% for median absolute relative difference. CGM reduced POC testing by ∼60% for patients on CII. Conclusions: In this real-world preliminary analysis of rtCGM during critical illness, we demonstrate early feasibility, considerable accuracy, and meaningful reduction in the frequency of POC glucose testing.
MeSH term(s)	Adult ; Aged ; Blood Glucose/analysis ; COVID-19 ; Critical Care ; Critical Illness/therapy ; Female ; Humans ; Insulin/therapeutic use ; Insulin Infusion Systems ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Point-of-Care Systems ; SARS-CoV-2
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2020-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	441231-x
ISSN	1935-5548 ; 0149-5992
ISSN (online)	1935-5548
ISSN	0149-5992
DOI	10.2337/dc20-2219
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Article ; Online: Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience.

Rhee, Harin / Jang, Gum Sook / Kim, Sungmi / Lee, Wanhee / Jeon, Hakeong / Kim, Da Woon / Ye, Byung-Min / Kim, Hyo Jin / Kim, Min Jeong / Kim, Seo Rin / Kim, Il Young / Song, Sang Heon / Seong, Eun Young / Lee, Dong Won / Lee, Soo Bong

BMC emergency medicine

2022 Volume 22, Issue 1, Page(s) 138

Abstract: ... to critically ill non-COVID-19 patients requiring continuous renal replacement therapy (CRRT) during the pandemic ... and during (January 2021 to March 2021) the pandemic.: Results: The mean number of critically ill ... and cancer (before: 19.4%; after: 32.3%; p < 0.001) increased during the pandemic. The time ...

Abstract	Background: During the COVID-19 pandemic, maintenance of essential healthcare systems became very challenging. We describe the triage system of our institute, and assess the quality of care provided to critically ill non-COVID-19 patients requiring continuous renal replacement therapy (CRRT) during the pandemic. Methods: We introduced an emergency triage pathway early in the pandemic. We retrospectively reviewed the medical records of patients who received CRRT in our hospital from January 2016 to March 2021. We excluded end-stage kidney disease patients on maintenance dialysis. Patients were stratified as medical and surgical patients. The time from hospital arrival to intensive care unit (ICU) admission, the time from hospital arrival to intervention/operation, and the in-hospital mortality rate were compared before (January 2016 to December 2019) and during (January 2021 to March 2021) the pandemic. Results: The mean number of critically ill patients who received CRRT annually in the surgical department significantly decreased during the pandemic in (2016-2019: 76.5 ± 3.1; 2020: 56; p < 0.010). Age, sex, and the severity of disease at admission did not change, whereas the proportions of medical patients with diabetes (before: 44.4%; after: 56.5; p < 0.005) and cancer (before: 19.4%; after: 32.3%; p < 0.001) increased during the pandemic. The time from hospital arrival to ICU admission and the time from hospital arrival to intervention/operation did not change. During the pandemic, 59.6% of surgical patients received interventions/operations within 6 hours of hospital arrival. In Cox's proportional hazard modeling, the hazard ratio associated with the pandemic was 1.002 (0.778-1.292) for medical patients and 1.178 (0.783-1.772) for surgical patients. Conclusion: Our triage system maintained the care required by critically ill non-COVID-19 patients undergoing CRRT at our institution.
MeSH term(s)	Acute Kidney Injury/epidemiology ; Acute Kidney Injury/therapy ; COVID-19/epidemiology ; COVID-19/therapy ; Continuous Renal Replacement Therapy ; Critical Care ; Critical Illness/therapy ; Humans ; Intensive Care Units ; Pandemics ; Renal Replacement Therapy ; Retrospective Studies
Language	English
Publishing date	2022-08-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050431-7
ISSN	1471-227X ; 1471-227X
ISSN (online)	1471-227X
ISSN	1471-227X
DOI	10.1186/s12873-022-00693-7
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Article ; Online: Continuous renal replacement therapy and extracorporeal membrane oxygenation: implications in the COVID-19 era.

Roberts, Sophia H / Goodwin, Matthew L / Bobba, Christopher M / Al-Qudsi, Omar / Satyapriya, S Veena / Tripathi, Ravi S / Papadimos, Thomas J / Whitson, Bryan A

Perfusion

2021 Volume 38, Issue 1, Page(s) 18–27

Abstract: ... renal replacement therapy (RRT) during ECMO support. The indications for initiating RRT in patients on ECMO are similar ... ECMO) should be considered as a rescue therapy in COVID-19-related ARDS. International registries ... anticoagulation strategies, and novel cytokine filtration approaches to minimize COVID-19's pathophysiological ...

Abstract	The novel severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus Disease 19 (COVID-19)) was identified as the causative agent of viral pneumonias in Wuhan, China in December 2019, and has emerged as a pandemic causing acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. Interim guidance by the World Health Organization states that extracorporeal membrane oxygenation (ECMO) should be considered as a rescue therapy in COVID-19-related ARDS. International registries tracking ECMO in COVID-19 patients reveal a 21%-70% incidence of acute renal injury requiring renal replacement therapy (RRT) during ECMO support. The indications for initiating RRT in patients on ECMO are similar to those for patients not requiring ECMO. RRT can be administered during ECMO via a temporary dialysis catheter, placement of a circuit in-line hemofilter, or direct connection of continuous RRT in-line with the ECMO circuit. Here we review methods for RRT during ECMO, RRT initiation and timing during ECMO, anticoagulation strategies, and novel cytokine filtration approaches to minimize COVID-19's pathophysiological impact.
MeSH term(s)	Humans ; COVID-19/therapy ; Continuous Renal Replacement Therapy ; SARS-CoV-2 ; Extracorporeal Membrane Oxygenation/methods ; Respiratory Distress Syndrome/therapy
Language	English
Publishing date	2021-09-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591211042561
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