Which dialysis method should be used for patients with COVID-19?

Abstract

KEY FINDINGS
• Very low-quality evidence from a single retrospective study suggests that continuous renal replacement
therapy (CRRT) may reduce mortality among COVID-19 patients on invasive mechanical ventilation. Guidelines
recommend CRRT for critically ill patients to minimize the risk of possible transmission, if this option is available.
• Although uncommon, acute kidney injury (AKI) can occur in association with coronavirus disease 2019
(COVID-19) and is associated with increased in-hospital mortality.
• There are currently no published or ongoing clinical trials directly comparing dialysis modalities for acute
kidney injury in COVID-19 patients.
• In reducing the risk of transmission during dialysis: currently, there are no studies comparing one dialysis
modality to another. The method of dialysis is still primarily determined by the clinical picture of the patient, the
expertise of the center, and the resources available. The American Society of Nephrology (ASN) recommends
CRRT over intermittent hemodialysis (IHD) for critically ill patients with COVID-19 to minimize patient contact
when it is available, and resources allow. Otherwise, intermittent hemodialysis may be done provided that,
infection control measures are strictly followed.
• Several international and local guidelines recommend strict adherence to infection prevention and control
measures (e.g. hand hygiene, physical distancing, proper use of personal protective equipment (PPE), and
cohorting of patients) who are undergoing dialysis.