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Kidney Complications in COVID-19 Send Hospitals Scrambling

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What your doctor is reading on Medscape.com:

APRIL 20, 2020 — After the devastating respiratory consequences of COVID-19 and resulting ventilator shortages, acute kidney injury is the next emerging healthcare and resource issue in this pandemic.

The prevalence of kidney failure in some ICUs is so high that centers are running out of dialysis machines and even dialysate solution. At the same time, they’re struggling to maintain access for noninfected patients.

Clinicians are devising creative solutions and workarounds but are also cautioning that acute kidney injury (AKI) is driving up patient deaths and may be a lingering sequela of the novel coronavirus.

“People are kind of shooting from the hip,” said Joel Topf, MD, assistant clinical professor of medicine, Oakland University William Beaumont School of Medicine in Detroit, and co-creator of the nephrology journal club, NephJC. “They’re doing the best they can, but a lot of what we would like to do is curbed by resource utilization.”

COVID-19 patients, he noted, are “tremendously catabolic” with hyperkalemia, hyperphosphatemia, and profound metabolic acidosis to a degree not seen in typical kidney failure patients.

“This ends up driving a lot of dialysis; the patient’s potassium is 7, so we absolutely need dialysis today, can’t wait, and we just don’t see this typically,” he told Medscape Medical News.

“This is acute kidney injury of a different stripe than we’re typically seeing in really sick people,” he commented.

Early COVID-19 reports rarely mentioned AKI or kidney failure. Other reports indicated that SARS-CoV-2 infection did not result in AKI or aggravate existing kidney disease among hospitalized patients in Wuhan, China.

“Many publications completely omit the complications of kidney failure, even in the ICU,” Matthew Sparks, MD, assistant professor of medicine, Duke University, Durham, North Carolina, and cofounder of the AJKD blog, told Medscape Medical News. “This is a very big problem. We’re starting to see more data come out, but it’s still a very slow trickle.”


AKI Incidence

Publications regarding ICU patients showed that the incidence of AKI varied but was more or less 5% and that 5% were treated with RRT, said Eric Hoste, MD, PhD, intensive care unit, Ghent University Hospital, Belgium, and chair of the AKI section of the European Society of Intensive Care Medicine (ESICM).

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