Background To date it is unclear whether SARS-CoV-2 is present in spent dialysate from peritoneal dialysis (PD) patients with COVID-19. Our aim was to assess the presence or absence of SARS-CoV-2 in spent dialysate from chronic PD patients with confirmed diagnosis of COVID-19. Methods Spent PD dialysate samples from COVID-19 positive PD patients were collected between March and August 2020. The multiplexed real-time reverse transcriptase-polymerase chain reaction assay contained primer/probe sets specific to different SARS-CoV-2 genomic regions and to bacteriophage MS2 as internal process control for nucleic acid extraction. Demographic and clinical data were obtained from patients' electronic health records. Results A total of 26 spent PD dialysate samples were collected from 11 patients from 10 dialysis centers. Spent PD dialysate samples were collected on average 25±13 days (median 20, range 10 to 45) after onset of symptoms. The temporal distance of PD effluent collection relative to the closest positive nasal swab RT PCR was 15±11 days (median 14; range 1 to 41). All 26 PD effluent samples tested negative at three SARS-CoV-2 genomic regions. Conclusions Our findings indicate the absence of SARS-CoV-2 in spent PD dialysate collected 10 days or later after the onset of COVID-19 symptoms. We cannot rule out presence of SARS-CoV-2 in spent PD dialysate in the early stage of COVID-19.

<b><i>Introduction:</i></b> Constipation is prevalent in patients with kidney failure partly due to the use of medication, such as phosphate binders. We hypothesized that serum levels of gut microbiome-derived uremic toxins (UTOX) may be affected by the choice of phosphate binder putatively through its impact on colonic transit time. We investigated two commonly prescribed phosphate binders, sevelamer carbonate (SEV) and sucroferric oxyhydroxide (SFO), and their association with gut microbiome-derived UTOX levels in hemodialysis (HD) patients. <b><i>Methods:</i></b> Weekly blood samples were collected from 16 anuric HD participants during the 5-week observational period. All participants were on active phosphate binder monotherapy with either SFO or SEV for at least 4 weeks prior to enrollment. Eight UTOX (7 gut microbiome-derived) and tryptophan were quantified using liquid chromatography-mass spectrometry. Serum phosphorus, nutritional, and liver function markers were also measured. For each substance, weekly individual levels, the median concentration per participant, and differences between SFO and SEV groups were reported. Patient-reported bowel movements, by the Bristol Stool Scale (BSS), and pill usage were assessed weekly. <b><i>Results:</i></b> The SEV group reported a 3.3-fold higher frequency of BSS stool types 1 and 2 (more likely constipated, <i>p</i> &#x3c; 0.05), whereas the SFO group reported a 1.5-fold higher frequency of BSS stool types 5–7 (more likely loose stool and diarrhea, not significant). Participants in the SFO group showed a trend toward better adherence to phosphate binder therapy (SFO: 87.6% vs. SEV: 66.6%, not significant). UTOX, serum phosphorus, nutritional and liver function markers, and tryptophan were not different between the two groups. <b><i>Conclusion:</i></b> There was no difference in the gut microbiome-derived UTOX levels between phosphate binders (SFO vs. SEV), despite SFO therapy resulting in fewer constipated participants. This pilot study may inform study design of future clinical trials and highlights the importance of including factors beyond bowel habits and their association with UTOX levels.

As SARS-CoV-2 continues to challenge hospital systems, the safety of heart transplantation must be evaluated. Retrospective review of all heart recipients transplanted at a single academic medical center in a U.S. SARS-CoV-2 epicenter found two patients with non-ischemic dilated cardiomyopathy. The 34-year-old male (ejection fraction <10%) was bridged to transplant with extracorporeal membrane oxygenation and microaxial left ventricular assist device. His perioperative course was uncomplicated except for transient SARS-CoV-2 seropositivity two months post-transplant. He was asymptomatic and remained so eight months to follow. The 20-year-old female (ejection fraction 5%) was bridged to transplant with microaxial left ventricular assist device. She progresses well with SARS-CoV-2 seronegativity eight months post-transplant. Our early experience suggests that intentional recipient, donor, and provider testing, cautious organ procurement, strategic intrahospital patient organization and transport, and well-coordinated follow-up permits uninterrupted provision of this definitive therapy for heart failure without subjecting these patients to greater risk.