SARS-CoV-2 in the peritoneal waste in a patient treated with peritoneal dialysis

Abstract

14 days for the household. 1 Dialysis patients can be considered as immunocompromised and display a decreased ability to develop seroconversion to infectious diseases. 2 Therefore, 7 to 14 days may not be an appropriate threshold in a dialysis population. In our center, we provide dialysis in 2 hospital-based and 6 satellite units, for a total of 664 patients (see Supplementary Methods). We isolated our COVID-19-positive dialysis outpatients in a dedicated unit and followed a pathway for de-escalation of stable patients with serial COVID-19 swabs, starting 7 days after confirmed diagnosis (Figure 1, Supplementary Table S1). Thirtyfour COVID-19-positive patients who had at least 3 swabs were included: 20 patients were de-isolated in less than 14 days (59%) with 9% on day 9. By day 12, 35% of patients could be dialyzed in their base unit (which is crucial for capacity). However, by day 15, 14 patients (41%) had not cleared the virus and could not be repatriated: 5 patients cleared the virus later (median of 18 days [range, 16-21]) and 9 patients were still positive or had only one negative swab at the end of follow-up. It is unclear whether detection of viral RNA represents the ability to transmit the virus, 3,4 but until more evidence is available, it would be prudent to isolate patients as discussed to prevent cross-contamination in this high-risk population.

COVID-19 in Hospitalized Patients on Chronic Peritoneal Dialysis: A Case Series

“…Owing to the temporal relationship of the COVID-19 illness and peritonitis, it is possible that SARS-CoV-2 might have been responsible for the peritonitis. Whether this is a direct effect of the virus, hematogenous spread, touch contamination, the effect of inflammatory mediators, superimposed bacterial translocation due to diarrhea, or another issue remains uncertain, although Vischini et al [9] previously reported peritoneal dialysate being positive for SARS-CoV-2 in a COVID-19 patient.…”

COVID-19 and the Kidney: From Epidemiology to Clinical Practice

“…Chest computed tomography reported bilateral multiple ground-glass opacities and laboratory tests showed mild lymphopenia, increased C-reactive protein and D-dimer levels. The patient's peritoneal dialysate was tested for SARS-CoV-2 by polymerase chain reaction, and was found to be positive [126]. According to the International Society Peritoneal Dialysis (ISPD) strategies regarding COVID-19 in peritoneal dialysis patients, the management of infection is the same for PD patients as for all other patients.…”

Technical note and clinical instructions for Acute Kidney Injury (AKI) in patients with Covid-19: Brazilian Society of Nephrology and Brazilian Association of Intensive Care Medicine

“…Peritoneal dialysate can be discarded in the same way, keeping the PPE on throughout the process. Although infrequent, there was a first report of detection, and persistence for more than 40 days, of SARS-CoV-2 in the peritoneal effluent of a patient with Covid-19 26 . Bags of wasted peritoneal dialysate can also be depleted in the sanitary network, with particular care to prevent spilling and the dispersion of its contents.…”