Nalesso Federico, Stefanelli Federica L, Di Vico Valentina, Cattarin Leda, Cirella Irene, Scaparrotta Giuseppe, Garzotto Francesco, Calò Lorenzo A
Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padua, 35128 Padua, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
Biomedicines. 2022 Aug 19;10(8):2017. doi: 10.3390/biomedicines10082017.
Critical clinical forms of COVID-19 infection often include Acute Kidney Injury (AKI), requiring kidney replacement therapy (KRT) in up to 20% of patients, further worsening the outcome of the disease. No specific medical therapies are available for the treatment of COVID-19, while supportive care remains the standard treatment with the control of systemic inflammation playing a pivotal role, avoiding the disease progression and improving organ function. Extracorporeal blood purification (EBP) has been proposed for cytokines removal in sepsis and could be beneficial in COVID-19, preventing the cytokines release syndrome (CRS) and providing Extra-corporeal organ support (ECOS) in critical patients. Different EBP procedures for COVID-19 patients have been proposed including hemoperfusion (HP) on sorbent, continuous kidney replacement therapy (CRRT) with adsorbing capacity, or the use of high cut-off (HCO) membranes. Depending on the local experience, the multidisciplinary capabilities, the hardware, and the available devices, EBP can be combined sequentially or in parallel. The purpose of this paper is to illustrate how to perform EBPs, providing practical support to extracorporeal therapies in COVID-19 patients with AKI.
新型冠状病毒肺炎(COVID-19)感染的重症临床形式通常包括急性肾损伤(AKI),高达20%的患者需要肾脏替代治疗(KRT),这进一步恶化了疾病的预后。目前尚无针对COVID-19的特效药物治疗,支持治疗仍是标准治疗方法,其中控制全身炎症起着关键作用,可避免疾病进展并改善器官功能。体外血液净化(EBP)已被提议用于脓毒症中细胞因子的清除,可能对COVID-19有益,可预防细胞因子释放综合征(CRS),并为重症患者提供体外器官支持(ECOS)。针对COVID-19患者,已提出了不同的EBP程序,包括基于吸附剂的血液灌流(HP)、具有吸附能力的连续性肾脏替代治疗(CRRT)或使用高截留量(HCO)膜。根据当地经验、多学科能力、硬件设备和可用装置,EBP可按顺序或并行组合使用。本文旨在说明如何实施EBP,为COVID-19合并AKI患者的体外治疗提供实际支持。