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Abstract: PO0745

Clotting of Hemodialysis Catheters in Patients with Renal Failure with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Mallappallil, Mary C., Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • Ouyang, Jie, Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • John, Sabu, Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • Wagner, John D., Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • Thaxton, Mariah W., Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • Yap, Ernie, Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
  • Bajracharya, Siddhartha D., Health and hospital corporation New York City - Kings County Hospital, New York, New York, United States
Background

We are an inner-city hospital in New York that had a surge of patients diagnosed with COVID-19. Many of these patients had acute kidney injury (AKI) and required renal replacement therapy (RRT). NYC Health + Hospitals/Kings County has 40 adult intensive care unit (ICU) beds. ICU capacity expanded to a potential of 150 beds during the COVID-19 surge. The surge included patients transferred from other NY inner-city hospitals for critical care and RRT. Sequential obstacles were faced in providing hemodialysis (HD) to this expanded pool of AKI patients. Additional machines, supplies, staffing and organization were helpful. Clinicians noted that COVID-19 complications included hypercoaguability and we observed an increased frequency of clotting of hemodialysis catheters (HDC).

Methods


We examined the percentage COVID-19 tested renal failure patients with clotting of HDC access during the period March 1, 2020 to May 15, 2020.We collected data on 146 patients during the above period who had HD. We then compared those who were COVID-19+ positive confirmed by testing to those who were not COVID-19+ by testing. HDC clotting was identified by the use of alteplase. We compared our findings of the two groups to historical controls during a similar time period prior to the COVID-19 surge, between January 1 to February 29, 2020.

Results

We had 3,665 admissions between March 1 and May 15, 2020, of which 1,075 patients had a confirmed COVID + test during the admission. Of these, 773 patients were noted to have AKI from diagnosis codes in the electronic medical record. Of the146 patients who needed HD (including patients with AKI and CKD) 97 were COVID-19+ and 49 were negative. HDC clotting identified by the use of alteplase was noted in 27% of those who were COVID-19 + compared to 10% of those who were COVID-19 negative. (P value= 0.02 by Chi-square using SPSS Version 24). The percentage of patients with clotting of catheters in the non-COVID-19 group was comparable to historical controls.

Conclusion


Significantly more COVID-19+ patients had HD catheter clotting compared to non-COVID-19 patients. Increased clotting was noted as a barrier to providing optimal HD therapy. For this and other reasons, we initiated an urgent start acute peritoneal dialysis program to mitigate the challenges in delivering HD to COVID-19 patients.