BACKGROUNDAcute kidney injury (AKI) is common in patients treated with extracorporeal membrane oxygenation (ECMO). The RIFLE criteria demonstrate clinical relevance for diagnosing AKI and classifying its severity.OBJECTIVESTo systematically define the incidence, clinical course and outcome of AKI using the pediatric pRIFLE criteria.DESIGNRetrospective, medical records review.SETTINGSPediatric cardiac surgical intensive care units at a tertiary care hospital in Riyadh.PATIENTS AND METHODSWe reviewed the records of all pediatric patients that underwent cardiac surgery and required ECMO postoperatively between 1 January 2011 and 1 January 2016. AKI was classified according to the pRIFLE criteria 48 hours after ECMO initiation. Demographics and concomitant therapies for all patients were collected.MAIN OUTCOME MEASURE(S)Outcome was assessed by recovery from AKI at time of discharge, ICU stay and mortality.RESULTSFifty-nine patients needed ECMO after cardiac surgery during the study period. Their mean (SD) age and weight was 11.0 (16.5) month and 5.5 (3.6) kg, respectively. All patients had a central venoarterial ECMO inserted. Fifty-three patients (90%) developed AKI after ECMO initiation. The majority of patients (57%) were categorized as pRIFLE-Failure, having a higher mortality rate (28/34 patients, 82%) in comparison to the pRIFLE-Injury and pRIFLE-Risk groups. Twenty-nine patients (49%) required either peritoneal dialysis (PD), or renal replacement therapy (RRT) or both. For AKI vs non-AKI patients, there was a statistically significant difference between mean (SD) ECMO duration (9.0 [8.00] vs 6.0 [2.0] days; P=.02) and ICU stay (37.0 [41.0] vs 21.0 [5.0] days; P=.03), respectively. The overall mortality rate was 58%, with a significant difference (P=.03) between AKI and non-AKI groups. All the patients who survived had normal creatinine clearance at hospital discharge.CONCLUSIONThere is a high incidence of AKI in pediatric patients requiring ECMO after cardiac surgery, and it is associated with higher mortality, increased ECMO duration, and increased ventilator days.LIMITATIONSSingle-center retrospective analysis and the small sample size limited the precision of our estimates in sub-populations.

Background Individuals with end-stage kidney disease (ESKD) on dialysis are vulnerable to contracting COVID-19 infection, with mortality as high as 31 % in this group. Population demographics in the UAE are dissimilar to many other countries and data on antibody responses to COVID-19 is also limited. The objective of this study was to describe the characteristics of patients who developed COVID-19, the impact of the screening strategy, and to assess the antibody response to a subset of dialysis patients. Methods We retrospectively examined the outcomes of COVID19 infection in all our haemodialysis patients, who were tested regularly for COVID 19, whether symptomatic or asymptomatic. In addition, IgG antibody serology was also performed to assess response to COVID-19 in a subset of patients. Results 152 (13 %) of 1180 dialysis patients developed COVID-19 during the study period from 1st of March to the 1st of July 2020. Of these 81 % were male, average age of 52​ years and 95 % were on in-centre haemodialysis. Family and community contact was most likely source of infection in most patients. Fever (49 %) and cough (48 %) were the most common presenting symptoms, when present. Comorbidities in infected individuals included hypertension (93 %), diabetes (49 %), ischaemic heart disease (30 %). The majority (68 %) developed mild disease, whilst 13 % required critical care. Combinations of drugs including hydroxychloroquine, favipiravir, lopinavir, ritonavir, camostat, tocilizumab and steroids were used based on local guidelines. The median time to viral clearance defined by two negative PCR tests was 15 days [IQR 6–25]. Overall mortality in our cohort was 9.2 %, but ICU mortality was 65 %. COVID-19 IgG antibody serology was performed in a subset (n = 87) but 26 % of PCR positive patients (n = 23) did not develop a significant antibody response. Conclusions Our study reports a lower mortality in this patient group compared with many published series. Asymptomatic PCR positivity was present in 40 %. Rapid isolation of positive patients may have contributed to the relative lack of spread of COVID-19 within our dialysis units. The lack of antibody response in a few patients is concerning.

Background: End stage kidney disease patients on maintenance dialysis are vulnerable to contract COVID-19 infection and variable degrees of disease severity have been reported. SEHA Kidney Care (SKC) is the largest provider of dialysis services in the United Arab Emirates providing dialysis services to ~1180 patients, including ~80 patients on peritoneal dialysis. Mortality of COVID-19 among patients with ESKD on dialysis is high and ranges from 14 to 31% in different published series. Not much is known about antibody response to COVID-19 in this group of patients. Patient population demographics in the UAE are dissimilar to many other countries. The objective of this study was to describe the characteristics of patients and clinical staff who developed COVID-19 RT-PCR positivity and assess antibody response to COVID-19.Methods: We conducted a retrospective analysis to characterize features of COVID-19 in our adult dialysis population. In addition, IgG antibody serology was also performed to assess response to COVID-19. Results: The incidence of COVID-19 infection in our population was 13%. 81% of the patients were males, average age was 53.2 ± 12​ years, and 95% were on in-center haemodialysis. The majority of patients (68%) developed mild disease while 13% required critical care. Combinations of drugs including Hydroxychloroquine, Favipiravir, Lopinavir, Ritonavir, Camostat, Tocilizumab and steroids were used based on local guidelines. The median time to viral clearance was 15 days [IQR 6-26]. Overall mortality in our cohort was 9.2%.We performed COVID-19 IgG antibody serology in a subset (n=87) of RT-PCR positive patients. Interestingly, 23 (26%) patients did not develop any antibody response. We successfully implemented a regular screening strategy for patients and staff to identify asymptomatic carriers with an aim to isolate them from the rest of the cohort.Conclusions: Our study has highlighted an important finding of lack of antibody response in a quarter of patients with ESKD. This may have significant implications for this group of patients while efforts are underway to develop an effective vaccine against COVID-19. With regular screening of all dialysis patients and staff, asymptomatic carriers can be identified and prevent spread of COVID-19 within the dialysis units.

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