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Kidney Week

Abstract: PO0793

COVID-19 AKI to ESRD: A New Cohort of Dialysis-Dependent Patients

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Chacko, Eric J., Florida Atlantic University, Boca Raton, Florida, United States
  • Cummings, Jason, Florida Atlantic University, Boca Raton, Florida, United States
  • Richards, Marc, Florida Atlantic University, Boca Raton, Florida, United States
Introduction

The Covid-19 pandemic has resulted in a massive number of hospitalizations with widespread effects on the global healthcare system. More research is needed to understand the implications of the disease, particularly its effects on renal function. Although initial studies from China suggested otherwise, there is growing evidence for an association between Covid-19 and AKI.

Case Description

A 66-year old man with history of CKD IIIb presented to the ED with fever and dry cough for several days. On admission the patient was febrile and tachypneic. Labs were showed elevations in BUN, SCr and inflammatory markers. Chest CT revealed bilateral ground glass opacities and NP swab was positive for SARS-CoV-2. The patient was initially treated with hydroxychloroquine, levofloxacin, and IV fluids. Clinical status worsened, eventually requiring intubation and vasopressors. Renal function progressed to anuria. Bicarbonate, potassium binders and loop diuretics were attempted to treat renal failure. On hospital day 4 the patient was placed on CRRT however he remained anuric. CRRT was complicated by clotting episodes managed with circuit anticoagulation with unfractionated heparin. The patient slowly improved, was extubated 17 days later, and transitioned to IHD. The patient underwent tunneled catheter placement and was discharged 30 days after admission and remains on IHD.

Discussion

It is theorized that renal impairment in Covid-19 is due to virus entry into host cells via the ACE-2 receptor present in lungs and kidneys. Post-mortem kidney biopsies suggest that renal damage in Covid-19 is mediated through multiple mechanisms including direct cytotoxicity, immunologic deposition, and microthrombi-related tubular damage. Although our patient recovered after a prolonged hospital course, he remained anuric requiring IHD far sooner than anticipated with natural progression of CKD, illustrating the unforeseen consequences of Covid-19 on healthcare resource utilization. Early use of CRRT may have a role as a therapeutic modality via inflammatory cytokine removal, however consideration must be made for future resource utilization including alternative RRT measures such as acute PD for critically ill patients as supplies dwindle. As the cases of Covid-19 increases, a higher number of patients may not see a return of renal function despite recovery and RRT resource management will need to be prioritized.