Extra-renal purification in COVID-19 patients with acute kidney injury in intensive care unit: experience of the Grand Hôpital de l’Est Francilien, Meaux site during the first four waves of the pandemic

Abstract

Context and objective. Patients with COVID-19 admitted to intensive care sometimes require extra-renal purification (ERP) for various indications. However, the related data are paradoxically non-existent. The aim of the present study was to describe the extent and survival to the use of ERP. Methods. This was a historical cohort study focusing on patients with COVID-19 admitted to the multipurpose intensive care unit of the Grand Hôpital de l'Est Ile-de-France, Meaux site, during the period from March 2020 to December 2021. Patient survival was described by the Kaplan-Meier curves, and the different curves compared using the Log-rank test. Predictors of death were sought using Cox regression. Results. In total, 202 patients (mean age 63 ± 13.9 years, male sex 64.4%) were included. The prevalence of ERP was 29.2% in the entire cohort. Indications for ERP included oligoanuria, hyperkalemia and acute pulmonary edema. The techniques used were hemofiltration (69.4%), hemodiafiltration (13.5%) and hemodialysis (16.9%) and citrate represented the majority anticoagulant (79.7%). Survival probabilities were 94.8% at day 2, 78.9% at day 7, 68.0% at day 14 and 64.4% at day 21. The mortality rate was higher in patients who received hemodiafiltration (71.4%). Survival was also shorter in the hemodiafiltration group. Conclusion. Acute kidney injury is common in intensive care in patients with COVID-19, with notable recourse to ERP. Received: November 16th, 2024 Accepted: January 28th, 2025 https://dx.doi.org/10.4314/aamed.v18i2.4