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Kidney Week

Abstract: PO0679

Acute Peritoneal Dialysis with Percutaneous Catheter Insertion for COVID-19-Associated AKI in Intensive Care: Experience from a UK Tertiary Centre

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Braide-Azikiwe, Dandisonba Bamidele Chinwe, King's College Hospital, London, London, United Kingdom
  • Bowes, Elaine, King's College Hospital, London, London, United Kingdom
  • Bramham, Kate, King's College Hospital, London, London, United Kingdom
  • Tulley, Caroline, King's College Hospital, London, London, United Kingdom
  • Lioudaki, Eirini, King's College Hospital, London, London, United Kingdom
  • Cairns, Hugh, King's College Hospital, London, London, United Kingdom
  • Sharpe, Claire C., King's College Hospital, London, London, United Kingdom
Background

During the COVID-19 pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to increased demand for renal replacement therapy (RRT). There are considerable challenges providing RRT for large numbers of patients with COVID-19 and alternatives to continuous veno-venous hemodiafiltration therapies (CVVHDF) in intensive care units (ICU) are needed in both high and low-resource settings. Peritoneal dialysis (PD) can be initiated immediately after percutaneous insertion of the catheter, but there are concerns about impact on ventilation and RRT efficacy. We describe our recent experience of percutaneous catheter insertion and peritoneal dialysis in patients in ICU with COVID-19 infection.

Methods

Patients were selected according to local protocol and catheters inserted percutaneously using Seldinger technique by two experienced operators. Sequential Organ Failure Assessment score (SOFA) and ventilation requirements were recorded at time of insertion, and at 24 hours after insertion. Procedure complications, proportion of RRT provided by PD, renal recovery and RRT parameters during PD were assessed.

Results

Percutaneous PD catheters were successfully inserted in 32/39 (82.1%) patients after median of 10.0 (IQR 13.0, 19.0) days on ICU. No adverse events following insertion were reported, SOFA scores and ventilation requirements were comparable before and after insertion and adequate RRT parameters were achieved. Median proportion of RRT provided by PD following catheter insertion was 90.2% (IQR 77.5, 100).

Conclusion

PD provides a safe and effective alternative to CVVHDF in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.

Clinical Parameters of Patients Prior to and after Peritoneal Dialysis Catheter Insertion
Parameter, Median (IQR)
N=31(1 Missing)
24 hours Prior to PD Catheter Insertion24 hours After PD Catheter Insertion
Lowest PaO2: FiO2 Ratio22.0 (18.3, 30.0)22.5 (18.5, 31.0)
SOFA Score16.0 (15.0, 16.0)16.0 (15.0, 17.0)
Requirement for vasopressor support (N (%))
Median maximal dose of norepinephrine (µg/kg/min)
18 (46.2%)
0.13 (0.08, 0.22)
16 (41.0%)
0.17 (0.07, 0.32)

IQR: interquartile range; PD: Peritoneal Dialysis; PaO2 : FiO2 ratio (arterial oxygen partial pressure (PaO2 in mmHg) to fractional inspired oxygen (FiO2 expressed as a fraction)); SOFA: Sequential Organ Failure Assessment