Thank you @ISNkidneycare @ISPD1 for the webinar on #PD in #AKI

Lots of food for thought

Just been looking through my notes -

AKI reported in up to a third of ITU patients and just under half of them may require RRT with #COVID19

There is direct evidence of the invasion of SARSCoV-2 into kidney tissue and direct virulence of SARS-CoV-2, factors contributing to acute kidney injury included systemic hypoxia, abnormal coagulation, and possible drug or hyperventilation-relevant rhabdomyolysis

https://www.kidney-international.org/article/S0085-2538(20)30369-0/fulltext

Abnormal clotting leads to early filter clotting and line problems with CRRT and HD

What is the ideal RRT modality for AKI in #covid-19?

2 types of lung involvement in COVID19 pneumonia

Type 1 Near normal pulmonary compliance with isolated viral pneumonia
type 2 -Decreased pulmonary compliance
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02880-z

Prone ventilation sometimes helpful

Fluid balance not easy – even in the ICU

Does filtration help with the cytokine storm? NO

https://journals.lww.com/ccmjournal/Abstract/2002/01000/A_phase_II_randomized,_controlled_trial_of.16.aspx
https://journals.lww.com/ccmjournal/Abstract/2009/03000/Impact_of_continuous_venovenous_hemofiltration_on.1.aspx

What are the advantages of acute PD in the ITU for covid19 patients? But there are disadvantages too ..

And what about the raised Intra-abdominal pressure that PD generates?- does it affect respiratory capacity – no- not usually

https://www.tandfonline.com/doi/full/10.3109/0886022X.2013.876353

https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)32873-8

Principles of acute PD and its aims

ISPD guidelines for mx of AKI with PD http://www.pdiconnect.com/content/34/5/494.full.pdf+html

What is the evidence for acute PD in AKI?
https://doi.org/10.1002/14651858.CD011457.pub2

Good evidence from #savingyounglives programme from @ISN that acute PD does save lives
As well as studies from the critical care environment

And why PD ?

The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.
https://www.ncbi.nlm.nih.gov/pubmed/32105632 

what catheter ?

Fluids for acute PD- commercial vs DIY

PD prescription and clearance

High vs low intensive PD

Whats the ideal dwell time ?

Acute PD studies in critical care show it works

Flow chart for how to PD in AKI

Conclusion from Dr Cullis

Now nearer to home - London has had the bull of #COVID19 patients and their experience is fascinating

And finally the New Orleans experience - didn’t realise they had been hit as badly as New York

Thanks to all the speakers and the @ISNkidneycare and @ISPD1 for a hugely informative hour which I am sure will inform our management of AKI in #COVID19 in the ITU