Use of peritoneal dialysis for acute kidney injury during the COVID-19 pandemic in New York City: a multicenter observational study

Abstract

To demonstrate feasibility of acute peritoneal dialysis (PD) for acute kidney injury during the coronavirus disease 2019 (COVID-19) pandemic, we performed a multicenter, retrospective, observational study of 94 patients who received acute PD in New York City in the Spring of 2020. Patient comorbidities, severity of disease, laboratory values, kidney replacement therapy (KRT), and patient outcomes were recorded. Mean age was 61±11 years; 34% were women; 94% had confirmed COVID-19; 32% required mechanical ventilation on admission. Compared to the levels prior to initiation of KRT, mean serum potassium decreased from 5.1±0.9 to 4.5±0.7 on PD Day 3 and 4.2±0.6 mEq/L on Day 7 (p<0.001 for both); mean serum bicarbonate increased from 20±4 to 21±4 on PD Day 3 (p=0.002) and 24±4 mEq/L on Day 7 (p<0.001). After a median follow up of 30 days, 46% patients died and 22% had renal recovery. Male sex and mechanical ventilation on admission were significant predictors of mortality. The rapid implementation of an acute PD program was feasible despite resource constraints and can be lifesaving during crises such as the COVID-19 pandemic.

Outcomes following peritoneal dialysis for COVID-19-induced AKI: A literature review

“…11 PD catheter placement was performed by surgeons 5,8,9 and nephrologist. 4 One multicentric study 11…”

“…Five studies were single centre (four from the United States 5,8 –10 and one from the United Kingdom 4 ) and one study was multicentric. 11 PD catheter placement was performed by surgeons 5,8,9 and nephrologist. 4 One multicentric study 11 included data from previously published studies.…”

“…11 PD catheter placement was performed by surgeons 5,8,9 and nephrologist. 4 One multicentric study 11 included data from previously published studies. Pooled median age of included patients was 60.6 years (median of 58.8–62 years).…”

Timing of Kidney Support Therapy in Acute Kidney Injury: What Are We Waiting For?

“…RCTs on timing of KST included intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) only (Table 2). In the recent COVID pandemic, some centers relied on acute peritoneal dialysis to save lives due to resource constraints 36 .…”

Peritoneal Dialysis as a Renal Replacement Therapy Modality for Patients with Acute Kidney Injury

“…Moreover, treatment goals were achieved despite 17% of patients being started on treatment in overflow makeshift intensive care units with curtailed access to water and electricity where extracorporeal therapies would not have been possible. Additionally, treatment goals were achieved despite a high proportion of obese patients [ 19 ].…”