Renal replacement therapy and blood purification in the first months of a new coronavirus infection in Moscow hospitals
Objective. To analyze the experience of renal replacement therapy (RRT) and blood purification (BP) methods in Moscow hospitals in the first months of a new coronavirus infection SARS-CoV2 (COVID-19). Material and methods. We analyzed survey data on the use of RRT and BP procedures in ICU patients with COVID-19 between March 15, 2020 and August 01, 2020. Data were obtained from 30 hospitals. Results. COVID-19 pandemic led to significant mortality (80.8%) in ICU patients requiring RRT and BP. Dead patients were older than survivors (66.0 (57.0; 74.0) and 57.0 (44.5; 65.0) years, respectively, p=0.000), they received interleukin blockers and JAK kinase inhibitors less often (19.3% and 27.7%, respectively, p=0.027). Survivors received earlier RRT after admission to ICU (2 (1.0; 5.0) vs. 4 (1.0; 7.0) days, p=0.008). In these patients, RRT was often administered before mechanical ventilation (46% and 21.9%, respectively, p=0.000). In survivors, RRT was more often used for extrarenal indications (23.8% and 12.6%, respectively, p=0.001) and for CKD (24.6% and 13.3%, respectively, p=0.001), less often for AKI stage 3 (31.7% and 47.8%, respectively, p=0.001). Survivors had lower serum creatinine by 33.4% (p=0.002), SOFA score by 33.4% (p=0.000) and procalcitonin by 65% (p=0.019) before RRT compared to dead patients. In survivors, methods of apheresis (11.3% and 3.4%, respectively, p=0.005) and selective hemoadsorption of cytokines were more common (14.9% and 5.1%, respectively, p=0.000), duration of hemoperfusion procedures was higher by 11.2% (p=0.015). Conclusion. Literature and our own data indicate advisability of renal replacement therapy for AKI stage 2-3 and multiple organ failure stage 2. Delayed decision-making in critically ill patients may be accompanied by higher mortality rate.