Covid-19 and Renal Replacement Therapy: A Single-Center Perspective from Southern Italy

Introduction: The outbreak of cases of coronavirus disease (COVID-19), a very contagious disease, poses a serious threat to human health, especially in the elderly and in co-morbid populations like patients with kidney disease requiring renal replacement therapy (RRT). Furthermore, data about HD patients and how to best dialyze them during the COVID-19 pandemic are scarce. The aim of the study is to describe the organizational model and clinical outcomes of patients confirmed COVID-19 needing RRT, admitted in a COVID Hospital in Southern Italy. Methods: This study is a cohort study of hospitalized patients with COVID-19 enrolled at Miulli General Hospital, one of the major designated hospitals providing medical care for COVID-19 patients in the Apulia Region. We included all consecutive patients requiring RRT, either due to ESKD or AKI. Demographic data, information on clinical symptoms or signs at presentation, and laboratory results were extracted by the electronic medical record. A group of pair-matched COVID-19 patients, with normal renal function, were considered as controls. All the RRT sessions were performed with the Genius system. Results: From March 10 through May 24, 2020, Miulli Hospital admitted 217 patients with COVID-19 infection, including 11 (5%) maintenance HD and 29 critically ill patients (13.3%) referred for ICU admission, of whom 3 with AKI. Overall, 140 bedside treatments were performed in the COVID Hospital, 122 bicarbonate standard in 11 HD patients, and 18 sustained low-efficiency daily dialysis (SLEDD) in 3 patients with AKI. Mean session time and mean weekly sessions were 3.64 ± 0.40 hours, and 3.4 ± 0.45 HD/week; while session time has been 7.4 ± 0.58 hours for SLEDD. The phenotype and clinical symptoms at the admission were not different between HD patients and controls. Compared to non-HD, HD patients showed lower serum levels of inflammatory markers, but only C-reactive protein reached significant levels (p=0.030), and lower hospital stay (p=0.020). In-hospital mortality was not different between the two groups. All AKI patients showed a severe systemic hyperinflammation at the admission and died in ICU. Conclusions: Our data show that an organizational model based on the HD bedside with the Genius system, adopting the strict protocol, allows a personalized treatment with efficacy and safety for the patients and staff. The HD patients, SARS-Cov-2 infected, seem to have a lower inflammatory profile and shorter in-hospital stay compared with non-HD COVID-19 patients.