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Kidney Week

Abstract: PO0695

Filter Clotting, Anticoagulation, and Duration of Sustained Low-Efficiency Dialysis in Patients with COVID-19 and AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Wen, Yuang, Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Ledoux, Jason R., Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Ramanand, Akanksh, Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Scharwath, Kevin, Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Mundy, Destiney A., Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Mohamed, Muner, Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Lukitsch, Ivo, Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

There have been anecdotal accounts of shortened duration of renal replacement therapy (RRT) due to filter clotting in patients with COVID-19 and acute kidney injury (AKI) (CoV-AKI) requiring RRT (AKI-RRT). Thus, we examined the duration of runs of RRT in patients with CoV-AKI as well as in patients with AKI-RRT in the pre-COVID-19 era.

Methods

Among 161 patients with CoV-AKI, we identified patients with CoV-AKI who underwent RRT by sustained low efficiency dialysis (SLED) for ≥ 2 days (n = 52) (March-April 2020). As a control, we included patients with AKI without COVID-19 diagnosis who underwent SLED (n = 24) (non-CoV-AKI) in December of 2019, pre-COVID-19 era. We quantified the duration of RRT under various protocols of anticoagulation (AC) [no AC, citrate (CIT), regional heparin (rH), minimally intensive heparin (mIH), systemic low intensity heparin (sLH), systemic high intensity heparin (sHH) and sHH plus CIT (sHH+CIT)] by computing the duration (hours) of each SLED session (hrs of SLED/start) and the percentage of short SLED runs (< 6 hours).

Results

In CoV-AKI, the median hrs of SLED/start under each AC protocol were 6.1 for no AC, 5.4 for CIT, 10.6 for rH, 11.6 for mIH, 11.4 for sLH, 12.4 for sHH and 14.6 for sHH+CIT. As the AC intensified, the duration of SLED increased (chi-square for trend, p = 0.014). Pre-COVID-19, standard AC for non-CoV-AKI were no AC or CIT and had a longer median RRT duration compared to CoV-AKI under either no AC or CIT (10.2 vs 5.5 hrs of SLED/start, for non-CoV-AKI vs CoV-AKI, respectively, p = 0.021). Similarly, the proportion of patients with short runs was greater in CoV-AKI (under no AC or CIT) vs non-CoV-AKI (55% vs 19%, p = 0.01). When comparing the 3 more aggressive AC protocols (sLH, sHH and sHH+CIT) in CoV-AKI with non-CoV-AKI, the duration of RRT was similar (12.2 vs 10.2 hrs of SLED/start, p = 0.11) and the percentage of short SLED runs were also similar (10% vs 19%, p = 0.25).

Conclusion

RRT in CoV-AKI was associated with shorter duration of SLED compared to non-CoV-AKI, likely driven by increased filter and/or catheter clotting. Aggressive AC protocols with sHH with or without CIT in CoV-AKI were successful in restoring the duration of RRT back to that observed in patients with AKI-RRT in the pre-COVID-19 era.