Minimizing risks associated with renal replacement therapy in patients with Ebola virus disease

Acute kidney injury in Ebola virus disease Definitive studies describing the incidence of acute kidney injury (AKI) in patients with Ebola virus disease (EVD) are awaited. However, anecdotal reports emerging from Africa and centers treating small numbers of patients outside Africa suggest that AKI, often with severe electrolyte abnormalities, is a common finding in patients with EVD due to vomiting and diarrhea and is an important contributor to mortality. Since laboratory testing in these patients exposes health-care workers and laboratory personnel to additional risk and most patients with EVD have been treated in centers in West Africa with limited resources, AKI often goes undiagnosed, and renal replacement therapy (RRT) is not readily available to the vast majority of Africans with EVD. Therefore, most experience with providing RRT to patients with EVD has been in centers in Europe and the United States. Can RRT be provided to patients with EVD without infecting health-care workers? Though protocols have been established by inter national organizations, including Medecins Sans Frontieres, to minimize the risk of transmission of Ebola virus from patients to health-care providers, the experience in the United States underscores the importance of having extensively trained personnel and comprehensive systems in place. At the time this article was written, at least 18 patients with EVD had been treated outside of Africa, all in Europe and the United States. Most of these patients were health-care workers who were infected while caring for patients with EVD in Africa and were subsequently transported to their home countries for treatment. Of the nine patients treated for EVD in the United States, seven were infected in West Africa and two were nurses infected while caring for a patient with EVD in the United States. It is noteworthy that each person with EVD who was transported from Africa directly to hos