Outcomes of PD for AKI treatment during COVID-19 in New York City: A multicenter study

Abstract

Background: The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy). Methods: In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan–Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery. Results: The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27–0.82, p = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery ( p = 0.48). Conclusions: The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings.

Is It Time to Give Peritoneal Dialysis Its Due Place in Managing Acute Kidney Injury: Lessons Learnt from COVID-19 Pandemic

“…This observation was supported by the more recent reports of acute PD during the COVID-19 pandemic from New York and the UK, where 30-100% of patients were on mechanical ventilators [24,26,28,37]. Bowes et al reported that in 36 mechanically ventilated patients on PD, the Sequential Organ Failure Assessment (SOFA) score and the arterial oxygen partial pressure to fractional inspired oxygen concentration ratio (PaO 2 :FiO 2 ) remained unchanged 24 h after initiating PD.…”

“…Fully adjusted Cox regression analysis showed that the PD group had a significantly lower mortality risk (hazard ratio of 0.48; confidence interval 0.27–0.82; p 0.008). There was no difference in renal function recovery at 30 days between both groups [24].…”

COVID-19 and Kidney: The Importance of Follow-Up and Long-Term Screening

“…A study with 12-month follow-up reported that mortality in COVID-19 patients with renal involvement is higher even with hemodialysis compared to patients with hemodialysis but without COVID-19 infection [48]. An observational study from New York reported that compared to extracorporeal dialysis, the treatment of AKI with peritoneal dialysis was not associated with worse clinical outcomes [49]. Another study reported that mortality was higher in patients with hemodialysis compared to peritoneal dialysis and renal transplant patients, while mortality was higher in peritoneal dialysis and renal transplant patients compared to the general population.…”

Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury—A Review

“…In adults, the most common underlying factors leading to AKI requiring KRT included cardiovascular diseases, infectious diseases, renal diseases, respiratory diseases, and gastrointestinal diseases [35,41,42,77,78]. In addition, comorbidities in adult patients comprised diabetes mellitus, coronary artery disease, hypertension, CKD, heart failure, and liver cirrhosis [41,78].…”

“…According to various studies, the percentage of patients who recovered kidney function ranged from 9.3% to 60.3%, while 4.3% to 38.7% progressed to CKD, and 30.2-72% of patients died [34][35][36][37]39,41,77,78]. Randomized control trials or multicenter studies reported better outcomes [35,77].…”