Continuous extracorporeal treatments in a dialysis patient with COVID-19

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Nephrology

Background:

• The COVID-19 pandemic poses a significant global health challenge, with limited effective treatments for critically ill patients.
• The cytokine storm induced by SARS-CoV-2 is a key factor in COVID-19 pathogenesis, particularly in intensive care settings.
• The efficacy of extracorporeal treatments for mitigating cytokine storms in COVID-19 remains uncertain.

Observation:

• A 66-year-old male patient on maintenance peritoneal dialysis developed severe COVID-19.
• The patient underwent multiple extracorporeal treatments, including plasma exchange, direct hemoperfusion with polymyxin B, and continuous hemodiafiltration.
• Despite experiencing recurrent ARDS and cerebral infarction, leading to death, the patient's cytokine storm appeared to be modulated.

Findings:

• Extracorporeal treatments led to a decrease in serum IL-6 levels, suggesting a dampening effect on the cytokine storm.
• These interventions were effective in managing acute respiratory distress syndrome (ARDS) and secondary hemophagocytic lymphohistiocytosis.
• The patient ultimately succumbed to respiratory failure on day 30 post-admission.

Implications:

• This case highlights the potential benefit of early initiation of extracorporeal treatments in critically ill COVID-19 patients.
• Timely intervention with extracorporeal therapies may help manage severe inflammatory responses and complications associated with COVID-19.
• Further research is warranted to establish definitive guidelines for extracorporeal treatment protocols in severe COVID-19 cases.