In-House Production of Dialysis Solutions to Overcome Challenges During the Coronavirus Disease 2019 Pandemic

Lumlertgul, Nuttha; Tunstell, Paul; Watts, Christopher J.; Hanks, Fraser; Cameron, Lynda; Tovey, Linda; Masih, Vivek; McRobbie, Duncan; Srisawat, Nattachai; Hart, Nicholas; Leach, Richard; Barrett, Nicholas; Ostermann, Marlies

doi:10.1016/j.ekir.2020.10.031

Cited by 7 publications

(6 citation statements)

References 6 publications

(4 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…97 Approaches to mitigate this included moderating RRT intensity to conserve fluids, running accelerated high clearance RRT or PIRRT to allow machine sharing, in-house preparation of dialysis fluid, and early transition to IHD. [98][99][100] Peritoneal dialysis (PD) is rarely used in critical care due to concerns regarding unpredictable fluid balance, variable dialysis adequacy, potential peritoneal infection, and compromised ventilation due to diaphragmatic restriction. Also from a practical standpoint, there may be substantial challenges involved in delivering PD to patients who are ventilated in the prone position and intra-abdominal pressure may be increased.…”

Section: Renal Replacement Therapymentioning

confidence: 99%

COVID-19 and Acute Kidney Injury

Hilton

Boyer

Forni

et al. 2022

Critical Care Clinics

View full text Add to dashboard Cite

Synopsis Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalised with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains prevention of worsening kidney damage and in some cases the need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.

show abstract

Section: Renal Replacement Therapymentioning

confidence: 99%

COVID-19 and Acute Kidney Injury

Hilton

Boyer

Forni

et al. 2022

Critical Care Clinics

View full text Add to dashboard Cite

show abstract

“…Critical care bed capacity surged from 7.6 to 19.6 beds per 100,000 population [16]. The high prevalence of AKI and limited supply of consumables led to significant challenges and disruptions in KRT delivery [17,18].…”

mentioning

confidence: 99%

Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

Lumlertgul

Pirondini

Cooney

et al. 2021

Ann. Intensive Care

Self Cite

View full text Add to dashboard Cite

Background There are limited data on acute kidney injury (AKI) progression and long-term outcomes in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to describe the prevalence and risk factors for development of AKI, its subsequent clinical course and AKI progression, as well as renal recovery or dialysis dependence and survival in this group of patients. Methods This was a retrospective observational study in an expanded tertiary care intensive care unit in London, United Kingdom. Critically ill patients admitted to ICU between 1st March 2020 and 31st July 2020 with confirmed SARS-COV2 infection were included. Analysis of baseline characteristics, organ support, COVID-19 associated therapies and their association with mortality and outcomes at 90 days was performed. Results Of 313 patients (70% male, mean age 54.5 ± 13.9 years), 240 (76.7%) developed AKI within 14 days after ICU admission: 63 (20.1%) stage 1, 41 (13.1%) stage 2, 136 (43.5%) stage 3. 113 (36.1%) patients presented with AKI on ICU admission. Progression to AKI stage 2/3 occurred in 36%. Risk factors for AKI progression were mechanical ventilation [HR (hazard ratio) 4.11; 95% confidence interval (CI) 1.61–10.49] and positive fluid balance [HR 1.21 (95% CI 1.11–1.31)], while steroid therapy was associated with a reduction in AKI progression (HR 0.73 [95% CI 0.55–0.97]). Kidney replacement therapy (KRT) was initiated in 31.9%. AKI patients had a higher 90-day mortality than non-AKI patients (34% vs. 14%; p < 0.001). Dialysis dependence was 5% at hospital discharge and 4% at 90 days. Renal recovery was identified in 81.6% of survivors at discharge and in 90.9% at 90 days. At 3 months, 16% of all AKI survivors had chronic kidney disease (CKD); among those without renal recovery, the CKD incidence was 44%. Conclusions During the first COVID-19 wave, AKI was highly prevalent among severely ill COVID-19 patients with a third progressing to severe AKI requiring KRT. The risk of developing CKD was high. This study identifies factors modifying AKI progression, including a potentially protective effect of steroid therapy. Recognition of risk factors and monitoring of renal function post-discharge might help guide future practice and follow-up management strategies. Trial registration NCT04445259

show abstract

“…Additionally, emergency use authorization (i.e., regulatory authorization of medical products to be used in an emergency when there are no adequate approved and available alternatives) allowed dialysate solutions not approved in the United States (i.e., multiBic™/multiPlus™ solutions) to be supplied to US institutions. In addition to the actions taken by FMCNA to increase supply, some hospitals, on their own initiative, produced their own RRT bagged fluids (15). However, the production of dialysate fluids is regulated by the FDA, and FMCNA only operates within its regulated quality system in manufacturing and supplying dialysate fluids.…”

Section: Dialysis Fluidmentioning

confidence: 99%