Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Abstract

Background: The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. NYU Medical Center and affiliations, including NYC Health and Hospitals/Bellevue (BH), developed a plan to offset the increased needs for kidney replacement therapy (KRT). We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 acute kidney injury (AKI). Methods: Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the country, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Admitted adult patients with acute kidney injury (AKI) who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous veno-venous hemofiltration for treating intensive care unit patients, demonstrating efficacy with outcomes comparable to standard care. Results: From April 8, 2020 to May 8, 2020, 39 catheters were placed into 10 women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 (men) and 59.5 (women) years); men and women who expired were average 71.8 and 66.2 years. No episodes of peritonitis observed; nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions: Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing of dialysis treatments in health crises.

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

“…This was reported in four studies 4,5,8,10 and the proportion of the patients with renal recovery ranged from 33% to 55%. Chen et al 11 in the multicentric retrospective study reported 22% renal recovery in patients undergoing PD at a median follow-up period of 30 days.…”

“…Finally, six studies were included in this review after exclusion of nine studies (three case reports/series with less than five patients, two studies included data from already included articles, three review articles and one conference abstract) (Figure 1). 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.…”

“…The mortality reported in the studies varied from 43% to as high as 63% 4,5,8,10,12 (Table 1). A multicentric retrospective study from different centres in New York City reported an overall mortality of 45% in COVID-19 patients undergoing PD.…”

“…4,5 Effect of PD on ventilation in supine position 12 Caplin et al further reported that PD was well tolerated by ventilated patients. 10…”

Remote Nursing Assessment for Peritoneal Dialysis Users During Covid-19 Pandemic: An Systematic Review

“…The studies were 15 Second, acute PD during the COVID-19 pandemic providing lifesaving care to acutely ill patients could help other programs to avoid rationing dialysis care in health crises. 16 including those for providing dialysis. NYU Medical Center and affiliations, including NYC Health and Hospitals/Bellevue (BH Third, preventing the spread of infection effectively for health care workers, and patients which is very important for the protection and care of patients and health workers on dialysis patients with suspected or confirmed COVID-19.…”