key: cord-0873217-tlm36fka
authors: Banshodani, Masataka; Shintaku, Sadanori; Kawanishi, Hideki
title: Combination therapy for COVID‐19 in hemodialysis patients: Pharmacological treatments and renal replacement therapy based on the severity
date: 2021-09-22
journal: Ther Apher Dial
DOI: 10.1111/1744-9987.13737
sha: 2bc6ed549610277b0285ee71679c189ee10ed78f
doc_id: 873217
cord_uid: tlm36fka

nan

Dear Editor, The mortality risk of Coronavirus disease 2019 (COVID-19) is higher in dialysis patients than in nondialysis patients [1] . In dialysis patients, it is difficult to treat COVID-19 due to various comorbidities. We conducted a combination therapy of pharmacological treatments and renal replacement therapy (RRT) for hemodialysis (HD) patients with COVID-19 between December 2020 and April 2021.

The severity was defined as follows: mild (non-or mild pneumonia: presence of clinical or radiographic evidence of lower respiratory tract disease, oxygen saturation membrane; BFR, 100 ml/min; DFR, 500-1000 ml/h) and polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) for 3-6 h (BFR, 100 ml/min) were performed in critical patients. We used nafamostat mesilate or heparin sodium for anticoagulation.

All seven patients (two mild, one moderate, two severe, and two critical) received the combination therapy ( Table 1 ). The mild-severe patients recovered uneventfully and were discharged on foot. The critical patients received mechanical ventilation and tracheostomy. The overall 90-day survival rate was 100%.

Remdesivir [2] was approved as antiviral agents for severe-critical COVID-19, whereas favipiravir was approved for mild-moderate COVID-19 in Japan. Therefore, we used The other critical patient was complicated with subcutaneous emphysema, mediastinal emphysema, alopecia, simple herpes labialis, and cytomegalovirus antigenemia, but the respiratory status subsequently stabilized on mechanical ventilation.

Characteristics and outcomes of individuals with pre-existing kidney disease and COVID-19 admitted to intensive care units in the United States

Remdesivir for the treatment of Covid-19 -final report

Dexamethasone in hospitalized patients with Covid-19

Continuous hemodiafiltration with a cytokineadsorbing hemofilter for sepsis

these agents based on the severity. Dexamethasone was associated with lower mortality and shorter duration of hospitalization for severe and critical COVID-19 [3] , but is associated with various adverse events. In our critical patients, adverse events occurred. We used IVIG, antibiotics, antithrombotic agents, and protease inhibitors. However, the efficacy of these agents remains unclear. Moreover, we performed HD with PMMA membrane, CRRT with AN69ST membrane [4] , or PMX-DHP for removal of cytokines. However, there were few reports referring RRT for COVID-19. Further studies are warranted to confirm the efficacy of the abovementioned agents and RRT.Consequently, all seven HD patients with COVID-19 were survived by the combination therapy.

We thank all the medical, nursing, and technical staff from dialysis intensive care unit of Tsuchiya General Hospital for their dedicated care of our HD patients during the COVID-19 epidemic.

The authors declare no potential conflict of interest.

Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, JapanCorrespondence Masataka Banshodani, Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30, Nakajimacho, Naka-ku, Hiroshima 730-8655, Japan.Email: m-banshodani@tsuchiya-hp.jp ORCID Masataka Banshodani https://orcid.org/0000-0001-5200-460X Sadanori Shintaku https://orcid.org/0000-0001-9653-2279