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Abstract: PO0670

Acute Peritoneal Dialysis in Patients with COVID-19 and AKI: A Single-Center Experience in a Time of Crisis in the United States

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Sourial, Maryanne, Montefiore Medical Center, Bronx, New York, United States
  • Sourial, Mina, Montefiore Medical Center, Bronx, New York, United States
  • Dalsan, Rochelle, Montefiore Medical Center, Bronx, New York, United States
  • Graham, Jay A., Montefiore Medical Center, Bronx, New York, United States
  • Ross, Michael J., Montefiore Medical Center, Bronx, New York, United States
  • Chen, Wei, Montefiore Medical Center, Bronx, New York, United States
  • Golestaneh, Ladan, Montefiore Medical Center, Bronx, New York, United States
Introduction

In developed countries such as the United States, intermittent hemodialysis (iHD) or continuous renal replacement therapy (CRRT) are the primary mode of renal replacement therapy (RRT) for the management of AKI. However, during the COVID-19 pandemic, the ability to provide HD in our hospital system was overwhelmed due to the surge in the number of patients with AKI requiring RRT combined with severe personnel shortages related to illness. Studies have shown no difference in clinical outcomes between HD and PD for AKI. We describe our rapid adoption of an acute PD program during the COVID-19 surge.

Case Description

At Montefiore Medical Center (MMC), in Bronx, NY, the first patient with COVID-19 was admitted on March 11, 2020. As the number of patients with AKI rose, we initiated an acute PD program starting on March 25th. As of April 13th, there were 2,015 patients with COVID-19 admitted to MMC. From April 1st to April 22nd, 30 patients were initiated on PD with the help of surgery and interventional radiology who placed Tenckhoff catheters at bedside and under fluoroscopy, respectively. Of those 30 patients, 14 died, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Of the 8 patients discharged, 3 were still on PD and 5 had renal recovery (all were able to stop dialysis and 4 returned to baseline creatinine). Of the 8 patients still hospitalized, 4 patients were switched to iHD (3 due to fluid retention and 1 due to PD catheter malfunction), and 4 patients had renal recovery and were able to stop dialysis. Challenges to this program included lack of nurse training, difficulty securing supplies and irregular therapy provision and underdosing due to staffing shortages. Patients on medical wards received more frequent exchanges and did not have significant volume overload and metabolic derangements like those patients requiring intensive care.

Discussion

Despite challenges, we demonstrate the feasibility of acute PD as an alternative to HD in patients with COVID-19-associated AKI. In this single-center experience, we found that acute PD was more effective for stable patients on the wards than for patients with severe illness requiring intensive care.