Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

Srivatana, Vesh; Aggarwal, Vikram; Finkelstein, Fredric O.; Naljayan, Mihran; Crabtree, John H.; Perl, Jeffrey

doi:10.34067/kid.0002152020

Cited by 36 publications

(56 citation statements)

References 35 publications

(39 reference statements)

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“…Unease about the certainty of UF and clearance potential and misconceptions regarding complications or effectiveness despite many positive trials also contribute. 21 We observed a mortality rate of 63% for patients with stage 3 AKI receiving PD, comparable to or less than the mortality reported in other series of COVID patients with stage 3 AKI suggesting that we were able to deliver adequate therapy. 5,22,23 Furthermore, we were able to achieve this with a negligible complication rate, which is a tribute to the skill of the surgical team and the scrupulous technique of the PD and nursing staff.…”

Section: Resultssupporting

confidence: 78%

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

et al. 2020

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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.

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Section: Resultssupporting

confidence: 78%

“…16,17 It also continues to be used widely in children. [19][20][21] Nevertheless, there is a reluctance to use PD to treat adult patients in the ICU in the US. The reasons for this underutilization may be lack of familiarity with the technique by nephrologists, intensivists and nursing staff, and the ease of ordering CVVH by the physicians.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…4 There is scarcity in the literature on the use of PD to treat AKI in COVID-19 patients. 4 This could be due to lack of experience and knowledge by intensivist and nephrologist working in ICU, lack of facilities, the myths associated with PD, and most importantly the inability to insert PD catheter urgently by intensivist or nephrologist. Here we report the successful recovery of three patients with AKI secondary to COVID-19 who were admitted to ICU and started on tidal PD on a daily basis until their parameters normalize or urine output exceeds 1 L per day, then the PD prescription was modified accordingly ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Successfully treating three patients with acute kidney injury secondary to COVID-19 by peritoneal dialysis: Case report and literature review

et al. 2020

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Coronavirus Disease 2019 (COVID-19) is a pandemic disease that increased the burden on health-care system. In the Kingdom of Saudi Arabia, 74,795 cases have been reported until 26 May 2020 and the number of cases is rapidly increasing. The mortality rate of COVID-19 worldwide is 6.37%. Here we report three cases of acute kidney injury (AKI) secondary to pneumonia of severe COVID-19; they were treated with automated peritoneal dialysis (PD) with full recovery. To the best of our knowledge, few reports in the literature have discussed the use of PD in AKI secondary to COVID-19.

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“…Due to the high volume of patients needing PD and the closure of operating rooms in our institution, a plan was formulated, with the help of the transplant surgeons and interventional radiologists (who did not place PD catheters in the past), to place PD catheters. Similar to the description provided by Srivatana et al, 10 transplant surgeons placed flexible PD catheters at the bedside using laparoscopically assisted techniques for ICU patients while interventional radiologists placed flexible PD catheters under fluoroscopic guidance for non-ICU and nonintubated patients. The PD catheters were used immediately after placement with low volumes (1-1.5 L) for the first 24 hours, which were then increased to full volumes (2-2.5 L) thereafter.…”

Section: Our Process and Challengesmentioning

confidence: 99%

Urgent Peritoneal Dialysis in Patients With COVID-19 and Acute Kidney Injury: A Single-Center Experience in a Time of Crisis in the United States

Sourial

Dalsan

et al. 2020

American Journal of Kidney Diseases

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Bronx, NY, the first case of coronavirus disease 2019 (COVID-19) was admitted on March 11, 2020. At the height of the pandemic, there were 855 patients with COVID-19 admitted on April 13, 2020. Due to high demand for dialysis and shortages of staff and supplies, we started an urgent peritoneal dialysis (PD) program. From April 1 to April 22, a total of 30 patients were started on PD. Of those 30 patients, 14 died during their hospitalization, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Although the PD program was successful in its ability to provide much-needed kidney replacement therapy when hemodialysis was not available, challenges to delivering adequate PD dosage included difficulties providing nurse training and availability of supplies. Providing adequate clearance and ultrafiltration for patients in intensive care units was especially difficult due to the high prevalence of a hypercatabolic state, volume overload, and prone positioning. PD was more easily performed in non-critically ill patients outside the intensive care unit. Despite these challenges, we demonstrate that urgent PD is a feasible alternative to hemodialysis in situations with critical resource shortages. Complete author and article information provided before references.

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Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

Cited by 36 publications

References 35 publications

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

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

Successfully treating three patients with acute kidney injury secondary to COVID-19 by peritoneal dialysis: Case report and literature review

Urgent Peritoneal Dialysis in Patients With COVID-19 and Acute Kidney Injury: A Single-Center Experience in a Time of Crisis in the United States

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