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Kidney Week

Abstract: SA-OR09

Urgent Peritoneal Dialysis Catheter Placement at a New York City Hospital During the COVID-19 Pandemic

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Patel, Dhwanil, NYU Langone Health, New York, New York, United States
  • Caplin, Nina J., NYU Langone Health, New York, New York, United States
  • Tandon, Manish, NYU Langone Health, New York, New York, United States
Background

During the COVID-19 pandemic, there has been an unparalleled burden on nephrology services to provide kidney replacement therapy to patients admitted to the hospital with COVID-19, who develop severe AKI. Given the unprecedented surge in COVID-19 admissions, ability to provide inpatient hemodialysis and continuous kidney replacement therapy (CKRT) was quickly saturated. We present data from our acute peritoneal dialysis (PD) program that was quickly assembled to provide kidney replacement therapy due to shortage of hemodialysis and CKRT resources.

Methods

Patients admitted to an academic NYC hospital during COVID-19 pandemic with AKI requiring kidney replacement therapy were evaluated for candidacy for bedside PD catheter placement via cut-down method with the majority having COVID respiratory failure. A dedicated surgery team was assembled to place PD catheters within 12-24 hours of request by the nephrology team. Catheters were placed in patients with BMI up to 51. Patients requiring proning were not excluded. Exclusion criteria were prior lower abdominal surgery, known varices, or imminent death.

Results

Thirty-eight PD catheters were placed during the 4 week time period from April 8 to May 8, 2020. Majority of the catheters were placed bedside in an ICU setting (36/38 - 95%), with 2 being placed laparoscopically in the OR. There were no episodes of peritonitis. Three catheters required revision due to poor flows. Six catheters required floseal for bleeding along the catheter tract, which resolved without additional intervention. There were no major bleeding complications during PD catheter placement despite many patients being on systemic anticoagulation. Dwell volumes of up to 2.2L did not appear to have negative effects on the ability to ventilate patients. One patient required transition to hemodialysis due to catheter malfunction.

Conclusion

Acute peritoneal dialysis successfully allowed kidney replacement therapy for patients with severe AKI during the peak phase of the COVID-19 pandemic at our hospital in NYC. There were no major complications with acute PD catheter placements.