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Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19

María Luisa Serrano Salazar1, Jose Portolés1,2, Maria de Valdenebro Recio1

  • 1Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.

Blood Purification
|January 11, 2022
PubMed

Insights

Expanded hemodialysis (HDx) shows promise in managing severe COVID-19 patients requiring renal replacement therapy (RRT). HDx demonstrated superior cytokine and beta-2 microglobulin clearance, alongside reduced mortality compared to online hemodiafiltration (OL-HDF).

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe COVID-19 can trigger cytokine storms, necessitating immunosuppressive treatment.
  • Renal replacement therapy (RRT) offers a potential avenue for cytokine removal in COVID-19 patients with kidney injury.
  • Understanding the efficacy of different RRT techniques in managing cytokine profiles is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of online hemodiafiltration (OL-HDF) and expanded hemodialysis (HDx) in managing cytokine levels in COVID-19 patients requiring RRT.
  • To evaluate the impact of these RRT techniques on beta-2 microglobulin and albumin levels.
  • To assess the mortality rates associated with OL-HDF and HDx in this patient population.

Main Methods:

  • A prospective observational study involving 26 patients (18 COVID-19 on RRT, 8 controls).
  • COVID-19 patients on RRT were assigned to either OL-HDF or HDx based on Brescia group recommendations.
  • Cytokine, beta-2 microglobulin, and albumin levels were measured pre/post-dialysis and at 1-2 weeks, with comparisons made between techniques and a control group.

Main Results:

  • COVID-19 patients exhibited higher cytokine levels than controls, with those having acute kidney injury (AKI) showing even higher levels.
  • HDx demonstrated superior clearance of TNF-alpha and beta-2 microglobulin compared to OL-HDF.
  • Mortality rates were higher in the OL-HDF group than in the HDx group.

Conclusions:

  • HDx appears to be a safer and more effective RRT technique for COVID-19 patients with RRT requirements, offering better cytokine and beta-2 microglobulin clearance.
  • While not statistically significant due to sample size, preliminary data suggest HDx may reduce AKI incidence.
  • Further research is warranted, but HDx presents a promising approach for managing critically ill COVID-19 patients during current and future viral pandemics.
Abstract

Keywords:
COVID-19CytokineExpanded hemodialysisKidney disease

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