Continuous extracorporeal treatments in a dialysis patient with COVID-19
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CASE REPORT
Continuous extracorporeal treatments in a dialysis patient with COVID‑19 Yoshihito Nihei1 · Hajime Nagasawa1 · Yusuke Fukao1 · Masao Kihara1 · Seiji Ueda1 · Tomohito Gohda1 · Yusuke Suzuki1 Received: 7 August 2020 / Accepted: 18 September 2020 © The Author(s) 2020
Abstract The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill patients with COVID-19. Keywords COVID-19 · Plasma exchange · Continuous renal replacement therapy · Cytokine storm
Introduction Since the diagnosis of the first patient in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, has evolved into a pandemic [1]. As of 31 July 2020, over 17.5 million people have been infected with SARS-CoV-2 and more than 660, 000 individuals have died. SARS-CoV-2 infection leads to various syndromes including acute respiratory distress syndrome (ARDS), secondary haemophagocytic lymphohistiocytosis Yoshihito Nihei, Hajime Nagasawa and Yusuke Fukao have equally contributed to this manuscript. * Yusuke Suzuki [email protected] 1
Department of Nephrology, Faculty of Medicine, Juntendo University, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
(sHLH) and venous and arterial thromboembolic disease, especially in patients in the intensive care unit. The cytokine storm caused by SARS-CoV-2 infection, primarily characterised by elevated plasma concentrations of interleukin 6 (IL-6), plays a central role in COVID-19 [2]; therefore, its suppression is considered a key treatment approach in patients with COVID-19. Extracorporeal treatment approaches including plasma e
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