Nursing Care for Patients with COVID-19 infection with Acute Renal Failure Due to Septicemia and Treated with Cytokine Removal (Hemoperfusion): a Case Study

Abstract

Background: COVID-19 remains a global public health problem, especially in patients with severe disease who may develop serious complications such as acute kidney injury (AKI) and sepsis. One of the key mechanisms of this disease is the cytokine storm, which is caused by an overactive immune response, causing multiple organ damage and increasing mortality. Hemoperfusion and continuous renal replacement therapy (CRRT) are potential approaches to reduce complications and improve survival in patients with acute renal failure and severe sepsis.

Objectives: (1) To study the nursing care approach for COVID-19 patients with acute renal failure due to sepsis. (2) To evaluate the effects of hemoperfusion and CRRT on renal recovery and general condition of patients. (3) To compare the treatment outcomes in patients with different risk factors and disease severity.

Methodology: This study was a case study, selecting 2 COVID-19 patients with acute renal failure due to septicemia who were admitted to Vachira Phuket Hospital between April and May 2020. The data used in the study included patient medical records, clinical history, laboratory test results, and nursing guidelines. The data were analyzed using a holistic nursing approach, focusing on respiratory care, circulatory system, infection control, and renal rehabilitation.

Results: Case study 1 was a 57-year-old male patient with no underlying diseases who received Hemoperfusion combined with CRRT for 4 days. The results showed that the kidney function improved (Cr decreased from 2.39 mg/dL to 1.59 mg/dL and GFR increased from 30.55 to 47.48), and the inflammation level decreased. The patient was able to wean off the ventilator and was discharged from the hospital on day 36 of treatment. Case study 2 was a 64-year-old female patient with underlying hypertension and anemia who received Hemoperfusion combined with CRRT for 5 days. The results showed that Renal function did not improve (Cr increased from 1.90 mg/dL to 3.40 mg/dL and GFR decreased from 27.47 to 13.59) and had severe complications such as Ventilator-Associated Pneumonia (VAP), Septic Shock and ARDS, resulting in patients not responding to treatment and dying.

Conclusion: This study showed that Hemoperfusion with CRRT may help restore kidney function and reduce inflammation levels in COVID-19 patients with acute renal failure. However, age, comorbidities and other complications significantly affect treatment outcomes. Nurses play an important role in holistic care, especially in monitoring for infection, providing psychological support and managing complications. This study provides guidelines for developing more effective care for COVID-19 patients with acute renal failure in the future.