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Archivos de Medicina de Urgencia de México

2024, Number 2

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Arch Med Urg Mex 2024; 16 (2)

Acute kidney injury and replacement of kidney function with continuous veno-venous hemodiafiltration in patients with severe COVID-19 pneumonia in the intensive care unit

Vásquez-Rodríguez AL, Montelongo FJ, Trujillo-Martínez M, Galindo-Ayala J, Romo-Sánchez MG, Sanvicente-Sánchez JR

Language: Spanish
References: 26
Page: 94-101
PDF size: 377.79 Kb.


ABSTRACT

In countries like Mexico, where high blood pressure, type 2 diabetes, and obesity are public health problems, it is a priority to consider the kidney function of patients affected by SARS-CoV-2. As the COVID-19 infection progresses, organic complications develop, predominantly in critically ill patients managed in the Intensive Care Unit; those include shock, sepsis, acute cardiac injury, acute renal failure, and even multi-organ dysfunction.
In patients with severe COVID-19 infection, the kidney has been identified as a target organ for the clearance of the virus, causing acute kidney injury (AKI) that worsens the prognosis and increases the risk of death compared to those without develops AKI. There are various hypotheses about the mechanism associated with AKI; A cytopathic effect of the virus on kidney cells has been proposed, so there could be direct cell damage, the entry of the virus through the enzyme dipeptidyl peptidase 4 and ACE, which is up to 100 times more expressed in the kidney. kidney compared to lung.
Continuous slow renal replacement therapy or low-efficiency slow dialysis should be reserved for highly unstable patients, a situation that may occur in the severity of COVID-19. Likewise, an effort must be made to optimize renal replacement alternatives such as intermittent hemodialysis of shorter duration in case of hemodynamic stable state and in the case of continuous slow therapies, some publications1 show higher doses than conventional ones (40 to 50 mL/kg/ hour) in order to force greater convection, reduce time and optimize resources.


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