Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Abstract

. 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.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

“…The current study adopted the criteria of the Kidney Disease Improving Global Outcome (KDIGO) and International Society of Nephrology guidelines to classify the case definition of AKI. The AKI was defined as an increase in serum creatinine level more than 1.5 times from baseline value within a week or an increase in the absolute values of serum creatinine by 26.5 µmol/L within 48 h. 20 …”

“… 2 , 6 The specific effect of SARS-CoV-2 on the kidney is not yet fully understood and to what extent it increases the risk of AKI. 8 , 19 , 20 More evidence on clinical characteristics and outcomes of COVID-19-associated AKI is needed to optimise the management and prevention of these complications.…”

Kidney implications of SARS-CoV2 infection in children

“…The Acute Disease Quality Initiative (ADQI) has released management guidelines for AKI in COVID-19 [ 22 ]. Additional AKI guidelines have been developed by the COVID-LMIC (low- and middle-income countries) Task Force and Mahidol-Oxford Research Unit [ 23 ]. Pediatric-specific AKI guidelines have been released by the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care and the Canadian Association of Paediatric Nephrologists (summarized in Table 2 ) [ 24 , 25 ].…”

Acute kidney injury outcomes of COVID-19 confirmed patients in a Philippine tertiary hospital: A retrospective study

“…Also, long-term monitoring is needed to avoid the progression of AKI to chronic kidney disease (CKD) and reduce the associated mortality in high-risk populations [15]. As such, it is important to recognize means to promptly identify and prevent further renal injury and facilitate recovery of renal function in patients with and who are recovering from COVID-19 [16].…”