1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Am J Trop Med Hyg. 2021 Jan 11;104(3_Suppl):87-98. doi: 10.4269/ajtmh.20-1242.
Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.
目前针对 COVID-19 和急性肾损伤（AKI）患者的管理建议主要基于资源丰富地区（主要位于高收入国家）的证据。将这些建议应用于资源有限的环境中通常是不切实际的。我们报告了一套针对中低收入国家（LMICs） COVID-19 和 AKI 患者的预防、诊断和管理的实用建议。对于资源有限地区 COVID-19 患者的 AKI 预防，我们建议使用等渗晶体溶液来扩充血管内容量，避免使用肾毒性药物，并在呼吸衰竭患者中采用保守的液体管理策略。对于 AKI 的诊断，我们建议任何 COVID-19 患者出现血清肌酐水平升高而无可用历史值时，应考虑存在 AKI。如果无法进行血清肌酐检测，我们建议将蛋白尿患者视为可能存在 AKI。我们建议在社区卫生环境中根据资金和可用性扩大使用即时检测血清肌酐和唾液尿素氮检测。对于资源有限地区 COVID-19 和 AKI 患者的管理，我们建议谨慎使用静脉补液复苏。对于不需要急性呼吸窘迫综合征（ARDS）的透析患者，我们建议在可行的情况下优先使用腹膜透析（PD）。对于需要透析且患有 ARDS 的患者，我们建议在可行的情况下使用血液透析，以优化液体清除。当无法获得或负担不起商业生产的溶液时，我们建议使用当地生产的 PD 溶液。
