CRRT also helps in curbing cytokine storm in COVID-19 Patients: Study

Cytokine Storm appears to be common in severe cases of COVID-19

Cytokine Storm appears to be common in severe cases of COVID-19. This is an
umbrella term wherein a massive release of cytokines; i.e. immune proteins that may lead to
multi-organ involvement. This uncontrolled reaction can occur in a variety of conditions,
including infections, organ damage and autoimmune disorders. Cytokine Storm can be life-
threatening and may require urgent intervention.  Early studies suggest that up to 67 per cent of
hospitalised COVID-19 patients may present with additional organ dysfunction syndromes,
other than lungs that may be induced by a high level of circulating cytokines. [1]

Dr Rushi Despande, Nephrologist HN Reliance & Jaslok, Mumbai said. “According to
Chinese researchers with much experience of managing COVID-19 patients, Continuous Renal
Replacement Therapy (CRRT) is not just renal support but also helps in curbing the cytokine storm and multi-organ support in critically ill patients. [5] In situations where patients may not be able to sustain rapid changes in body fluid balance and metabolic fluctuations and in situations where other extracorporeal therapies are required like invasive ventilator support, continuous RRT can be used as an integrated system and are preferred over parallel systems’’.

“As per the recommendation of American Society of Nephrology and in the COVID-19 pandemic
scenario, the CRRT maybe one of the preferred modalities, especially for those who have
hemodynamic instability. CRRT is a blood purification therapy applied for 24 hours a day. At
present, among the other therapies being used, CRRT is beneficial to maintain volume balance,
hemodynamic stability and to improve the clearance efficiency of middle-sized molecules such as
cytokines especially when used with adsorptive filters which can help with the improved clearance of cytokines from circulation”, [7] said Dr M M Bahadur, Nephrologist, Jaslok, Mumbai.
He further added, “One such adsorptive filter available in India is Oxiris, which amidst the COVID-19 pandemic crisis has also received emergency use authorisation from the US Food and Drug
Administration (FDA) for COVID-19 treatment, moreover this filter set can be used to perform
multiple blood purification therapies simultaneously, including cytokine removal or/and CRRT.”

In addition to the above-mentioned benefits, Chinese researchers recommend CRRT treatment
should also be used in other non-renal indications, especially to control cytokine storm,
appropriate early intervention should be made when ARDS, right heart failure and capacity
overload occurs at the initial stage, CRRT should be activated to implement three-level
management capacity to better support cardiopulmonary function. [8]  Overall, along with
ventilators the hospitals should also plan and manage adequate supply for dialysis equipment
and associated supplies not only for outpatient use but also for critically ill patients in intensive
care units.

References:
1. Ronco C, Reis T, De Rosa S. Coronavirus epidemic and extracorporeal therapies in
intensive care: si Vis pacem para bellum [published online ahead of print, 2020 Mar 13].
Blood Purif. 2020; 1–4. doi:10.1159/000507039
2. https://www.asn-online.org/ntds/resources/Webcast_2020_04_21_AKI!NOW.mp4
3. Chinese Medical Association, Expert consensus on the Application of Special Blood
purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese
Medical Association Professional Committee of Nephrology, Chinese Research Hospital
Association
4. Yi Yang*, Jia Shi*, Shuwang Ge et al. Effect of continuous renal replacement therapy on
all-cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a
retrospective cohort study. https://doi.org/10.1101/2020.03.16.20036780
5. Chinese Medical Association, Expert consensus on the Application of Special Blood
purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese
Medical Association Professional Committee of Nephrology, Chinese Research Hospital
Association
6. Chinese Medical Association, Expert consensus on the Application of Special Blood
purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese
Medical Association Professional Committee of Nephrology, Chinese Research Hospital Association