key: cord-0825915-z93zhu2r
authors: Xing, Xue; Yi, Yang; Shi, Jia; Cheng, Anying; Wang, Yanan; Gang, Xu; He, Fan
title: Severe COVID-19 in a patient with chronic kidney disease: is there a positive effect of continuous venovenous hemodiafiltration?
date: 2020-09-29
journal: Nefrologia
DOI: 10.1016/j.nefro.2020.07.005
sha: 9acdba82cbf038e99c1d0cd68ee2ec4fcf69114b
doc_id: 825915
cord_uid: z93zhu2r

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Informed consent has been obtained from the patient for publication of the letter to editor and accompanying images. The study was approved by the medical Ethics Committee of Tongji Hospital Affiliated to Medical College, Huazhong University of Science and Technology (TJ-IRB20200422).

This work was supported by National Natural Science Foundation of China (NSFC 81974089, 81470934) and Science Foundation of Hubei Province (2018CFB554, 2019CFB675). for "fever for 14 days and dyspnea for 4 days". Nine days before her admission, diagnosis of this patient was confirmed by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction testing (RT-PCR) test and chest CT in clinic and the antiviral drug arbidol was taken orally.

On admission, her oxygen saturation was maintained 95% on the use of bilevel positive airways pressure (BiPAP). Blood sample tests revealed lymphopenia, increased neutrophil ratio and inflammatory cytokines, such as IL-2, IL-2 receptor (IL-2R), IL-6 and tumor necrosis factor-α (TNF-α).

( Table 1 ) She had chronic kidney disease for 5 years and serum creatinine was generally maintained at 200umol/L for 2 years. However, her serum creatinine was 657umol/l on admission which revealed acute kidney injury (AKI). CT scan on the day of admission showed ground-glass opacity in both lungs. We showed the most severe lesion in Figure 1A . On the second day of admission, Vascular access was obtained via a flexible doublelumen catheter placed in the femoral vein. The patient underwent CVVHDF for 5 consecutive days and each lasted about 10 hours. Antivirus and antibiotics medications were also given. The patient released from the ventilator on the fifth day. Of note, plasma inflammatory cytokines concentrations and high-sensitivity C-reactive decreased after the CVVHDF. (Table 1 ) Furthermore, serum creatinine decreased from 657umol/l to 302umol/l and remained stable within 7 days, and we There is one figure uploaded separately. Scr,serum creatinine;IL-2,interleukin-2;IL-2R,IL-2 receptor;TNF-α,tumor necrosis factor-α; BUN, Blood urea nitrogen; NT-BNP, N-terminal brain natriuretic peptide

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The authors greatly appreciate all the Tongji hospital staff for their efforts in recruiting and treating patients and express gratitude to the patient.