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">https://www.kidney-international.org/article/S... 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">https://ccforum.biomedcentral.com/articles/... ventilation sometimes helpful

Fluid balance not easy – even in the ICU
What are the advantages of acute PD in the ITU for covid19 patients? But there are disadvantages too ..
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">https://www.pdiconnect.com/content/3...
What is the evidence for acute PD in AKI?
https://doi.org/10.1002/14651858.CD011457.pub2

Good">https://doi.org/10.1002/1... 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 ">https://www.ncbi.nlm.nih.gov/pubmed/32...
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
You can follow @renalpages.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: