Outcomes associated with tocilizumab use in patients with COVID-19 infection complicated by severe AKI requiring continuous renal replacement therapy

Background: The percentage of critically ill amongst COVID-19 infected patients stands at 5%. The incidence of acute kidney injury in those patients varies according to risk factors. A little is known about the use of Tocilizumab in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) Methods: This is a retrospective study of 22 COVID-19 patients. Patients were between 18 and 80 years old, had proven COVID-19 infection, were admitted to the ICU between April 1 and July 15, 2020, received CRRT and Tocilizumab parenterally. Other therapies included antivirals, hydroxychloroqine and convalescent plasma. We reported biochemical outcomes related to cytokine storm as well as clinical outcomes;Those included ventilator dependence, renal outcomes, length of hospital stay and mortality Results: 21 out of 22 patients were males. Median age was 56 years. 14 patients had hypertension and 13 had diabetes mellitus. All patients had cytokine storm on admission (elevated IL-6 and CRP levels). At the completion of the follow up (average 44.4 days), 20 out of 22 patients experienced improvement in IL-6 and CRP levels. 11 patients died. 13 experienced improvement in oxygen requirements including 9 who were succesfully extubated. 13 were still on CRRT (including 10 patients who died) while 9 patients became dialysis independent (5 had complete recovery of kidney function and 4 developed chronic kidney disease). There was no reported side effect from using tocilizumab Conclusions: Tocilizumab can be considered in critically ill COVID-19 patients with severe AKI and cytokine storm. No dose adjustment is needed in patients on CRRT. Further studies are required to confirm our results.