Early initiation of renal replacement therapy (RRT) may reduce death risk among patients with severe COVID-19, according to Chinese researchers.

Of 58 adults with severe COVID-19 in the intensive care unit (ICU) during February 9 to March 30, 2020, medical teams started 20 patients (34.5%) who displayed cytokine storm and organ injury on early RRT. RRT commenced within 6.4 days of ICU admission and 24.1 days from COVID-19 onset. The mean age of the entire cohort was 68.4 years, and 81.0% of patients had at least 1 comorbidity prior to hospitalization. A total of 34 patients died.

Early RRT was associated with a significant 72% lower risk of all-cause mortality in the ICU, Jing Qian, MD, of Huashan Hospital Fudan University in Shanghai, China, and colleagues reported in a 2021 World Congress of Nephrology abstract published in Kidney International Reports. The incidence of sudden unexpected death was significantly lower in the early RRT than no RRT group: 0.2 vs 2.9 per 100 person-days.

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According to Dr Qian’s team, early RRT can reduce in-hospital mortality, especially sudden unexpected death, in patients with severe COVID-19. Early RRT did not improve multi-organ impairment, however. Patients who underwent early RRT did not appear to have increased risk for acute kidney injury.

Early initiation of RRT should be a treatment option for critically ill patients with COVID-19, the investigators concluded.


Qian J, Wang M, You H, et al. Early renal replacement therapy may reduce the all-cause mortality of severe COVID-19. Kidney Int Rep 6(4):S249-S250. Abstract POS-045. doi:10.1016/j.ekir.2021.03.051