Table 1.

Proposed approach for early identification of AKI and for providing RRTs in patients with COVID-19

1.Identify risk factors for AKI (e.g., chronic kidney disease, heart failure, chronic liver disease, diabetes, and age ≥65 yr)

2.Close and continuous communication between nephrologists and the rest of the COVID-19 health care team (i.e., infectious disease specialist, pulmonologist, and the intensive care team).

3.Early identification of patients with KDIGO AKI stage 1 or 2 is essential as it allows prompt interventions and better outcomes (i.e., achieving and maintaining optimal fluid status). This could reduce AKI progression and improve mortality.

4.If a patient presents with severe AKI but does not meet any absolute criteria for RRT initiation, we recommend optimizing medical management until kidney failure becomes life threatening.

5. Absolute indications for starting RRT are as follows: ∗ Life-threatening hyperkalemia ∗ Refractory fluid overload ∗ Severe metabolic acidosis

6.For patients on chronic RRT (i.e., CAPD, IHD, or APD), the decision to continue or to change RRT should be made promptly and assessed daily. For example: If a patient is treated with CAPD and requires better solute control, the patient will be switched from CAPD to APD, and the prescription will be modified. If solute and/or volume control is not achieved, the patient will be placed on CRRT, PIRRT, or IHD.

7.RRT selection will be based on several factors, like patient’s hemodynamic stability, local availability, equipment, supplies, staff, and local expertise (Figure 1).

AKI, acute kidney injury; APD, automated peritoneal dialysis; CAPD; continuous ambulatory peritoneal dialysis; COVID-19, coronavirus disease 2019; CRRT, continuous renal replacement therapy; IHD, intermittent hemodialysis; KDIGO, Kidney Disease: Improving Global Outcomes; PIRRT, prolonged intermittent renal replacement therapy; RRT, renal replacement therapy.