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Kidney Week

Abstract: PO0100

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

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Caplin, Nina J., NYU Langone Health, New York, New York, United States
  • Tandon, Manish, NYU Langone Health, New York, New York, United States
  • Zhdanova, Olga, NYU Langone Health, New York, New York, United States
  • Amerling, Richard, Saint George's University, Saint George, Saint George, Grenada
  • Thompson, Nathan, NYU Langone Health, New York, New York, United States
Introduction

The dramatic spread of COVID-19 in March 2020 threatened to overwhelm ICU capacity. At the peak we had more than 120 patients in the ICU. About 40% of the ICU patients required RRT due to AKI. Our ability to provide RRT with CVVH and IHD was severely limited by critical shortages of equipment and personnel.
We rapidly established an acute PD program at Bellevue hospital for AKI patients.
The acute PD program turned out to be instrumental in the BH response to COVID AKI.

Case Description

Patients
All patients who needed RRT in the ICU were eligible to receive PD catheters except for those with prior abdominal surgery. 36/38 patients who received catheters were Covid (+). Proning was not always planned; we did not use this as a contraindication. We were able to successfully perform adequate PD on patients who were proned with minimal complications.
Surgical Support
Catheters were placed using a limited cut down to the peritoneal membrane through the rectus muscle at bedside; most of the patients were intubated and sedated.
Training and Initial Experience
A nurse affiliated with Bellevue’s outpatient dialysis unit helped make videos and trained the lead nephrologist on how to perform PD and how to use a Cycler. 25 people were on the PD team and we were able to provide exchanges 24 hours per day. Exchanges were initially performed manually every 1-2 hours. Eventually we acquired 18 cyclers which greatly eased the workload.
Outcomes
As of May 8, 2020 63 patients were evaluated, 38 PD catheters were placed with 35 used for exchanges. 2 patients had catheters placed but recovered renal function prior to starting PD. 1/38 was nonfunctioning and changed to IHD. 15/35 survived >30 days; 8 recovered renal function; 20 expired <30 days.

Discussion

Because of the shortage of our typically used dialysis modalities we were compelled to start an acute PD program. No patient on PD required additional dialytic support with IHD or CVVH. PD was well tolerated by ventilated patients with hemodynamic instability. Acute PD more than adequately filled the gap in treatment options during this unprecedented crisis