Table 1.

Recommendations and suggestions for the prevention and care of AKI among patients with COVID-19 in LMICs

1	Prevention of AKI	In patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions rather than colloids for expansion of intravascular volume (strong recommendation, moderate quality of evidence).
1	Prevention of AKI	In patients with COVID-19–related respiratory failure and AKI in LMICs, we recommend the use of a conservative fluid management strategy (strong recommendation, moderate quality of evidence).
1	Prevention of AKI	In patients with COVID-19 in LMICs, we suggest the avoidance or cessation of nephrotoxic drugs when their use is not essential (moderate recommendation, weak quality of evidence).
2	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 until proven otherwise to prevent treatment delay (weak recommendation, very low quality of evidence).
2	Diagnosis of AKI	In the absence of ability to test serum creatinine, we suggest the use of urinalysis in patients with COVID-19 to identify proteinuria. Patients with proteinuria should be considered as having possible AKI until proven otherwise, to prevent treatment delay (weak recommendation, very low quality of evidence).
2	Diagnosis of AKI	We suggest the expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow (weak recommendation, low quality of evidence).
2	Diagnosis of AKI	We suggest the implementation of AKI awareness and training initiatives among all levels of healthcare providers. Provider education should ideally include education on the prevalence of AKI in COVID-19 patients in addition to training on the presentation and diagnosis of AKI using available resources at individual healthcare facilities (ungraded, best practice statement).
3	AKI treatment, non-dialysis	We recommend the judicious use of intravenous fluid resuscitation using crystalloids for early management of AKI in all COVID-19 patients (strong recommendation, low quality of evidence).
3	AKI treatment, non-dialysis	We recommend more conservative fluid management for critically ill COVID-19 patients. Negative fluid balance should be maintained, if possible (strong recommendation, low quality of evidence).
3	AKI treatment, non-dialysis	We suggest the use of lung-protective mechanical ventilation strategies, where applicable, to prevent renal injury from associated cytokine release (weak recommendation, very low quality of evidence).
4	AKI treatment, dialysis	For AKI patients in LMICs with COVID-19 and no ARDS, we suggest using PD as first choice, where available and feasible (weak recommendation, low quality of evidence).
4	AKI treatment, dialysis	For AKI patients in LMICs with COVID-19 and ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal (weak recommendation, low quality of evidence).
4	AKI treatment, dialysis	We suggest using locally produced PD solutions when commercially-produced solutions are unavailable or unaffordable (weak recommendation, low quality of evidence).

AKI = acute kidney injury; ARDS = acute respiratory distress syndrome; LMICs = low- and middle-income countries; PD = peritoneal dialysis. Grading: See Appendix for detail.