Publication: Pragmatic recommendations for the prevention and treatment of acute kidney injury in patients with COVID-19 in low- And middle-income countries
Issued Date
2021-03-01
Resource Type
ISSN
14761645
00029637
00029637
Other identifier(s)
2-s2.0-85103253443
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 87-96
Suggested Citation
Kristina E. Rudd, Elif A. Cizmeci, Gabriela M. Galli, Ganbold Lundeg, Marcus J. Schultz, Alfred Papali Pragmatic recommendations for the prevention and treatment of acute kidney injury in patients with COVID-19 in low- And middle-income countries. American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 87-96. doi:10.4269/ajtmh.20-1242 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77312
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Title
Pragmatic recommendations for the prevention and treatment of acute kidney injury in patients with COVID-19 in low- And middle-income countries
Abstract
Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.