ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0824

Severe Hypertriglyceridemia Leading to CRRT Malfunction in a COVID-19 Patient

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Parikh, Rushang, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Barnett, Richard L., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction

Continuous renal replacement therapy (CRRT) is a therapy used in critically ill patients and is of particular importance with COVID-19. We present a patient with COVID-19 on propofol for sedation with persistent filter clotting issues found to have severe hypertriglyceridemia (SHT) corrected with lipopheresis. This case highlights the importance of managing all aspects of CRRT, the highly inflammatory state of COVID-19 and supply chain management during high utilization periods.

Case Description

A 41-year-old male with severe obesity and T2DM presented to the hospital with shortness of breath and fevers found to have COVID-19. The patient was intubated on presentation due to hypoxemic respiratory failure and admitted to the ICU. The patient was placed on Propofol for sedation. The patient presented with normal kidney function but peri-intubation had a rapid rise in creatinine to 4.00 mg/dL and was started on CRRT. It was noted that the CRRT circuit was continuously clotting within 30 minutes of initiation. The patient was also noted to have rising CPK levels and a concern for Propofol Infusion Syndrome (PRIS) was raised. A triglyceride level was checked and found to be 3286 mg/dL. The patient was initiated on insulin and heparin drips however due to CRRT issues and inadequate clearance a decision was made to perform lipopheresis to rapidly correct SHT. Patient underwent lipopheresis and the triglycerides dropped to 426 mg/dL. The heparin drip was continued and filter life greatly improved. The patient was continued on CRRT and adequate clearance was achieved.

Discussion

This case highlights important points for CRRT, COVID-19 and supply chain management. This patient was found to have PRIS however COVID-19 is a highly inflammatory state with a particularly robust response in patients with higher central adiposity. In this patient with metabolic syndrome, the addition of Propofol was a particular risk for SHT. With respect to the CRRT, a big indication to check triglycerides was the clotting of filters. Lipopheresis was indicated not only for the SHT but in order to help correct issues with CRRT and to achieve adequate clearance. Finally, during the COVID-19 crisis supply chain management was important with a shortage of CRRT machines, fluids and filters. In order to achieve optimal use of CRRT supply, adequate clearance, and correct SHT, lipopheresis was indicated.