TY - JOUR
T1 - Urgent Peritoneal Dialysis in Patients With COVID-19 and Acute Kidney Injury
T2 - A Single-Center Experience in a Time of Crisis in the United States
AU - Sourial, Maryanne Y.
AU - Sourial, Mina H.
AU - Dalsan, Rochelle
AU - Graham, Jay
AU - Ross, Michael
AU - Chen, Wei
AU - Golestaneh, Ladan
N1 - Funding Information:
Dr Chen is supported by the American Society of Nephrology Carl W. Gottschalk Research Grant and National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK114476).
Funding Information:
Maryanne Y. Sourial, DO, Mina H. Sourial, MD, Rochelle Dalsan, MD, MS, Jay Graham, MD, Michael Ross, MD, Wei Chen, MD, MS, and Ladan Golestaneh, MD, MS. Dr Chen is supported by the American Society of Nephrology Carl W. Gottschalk Research Grant and National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK114476). Dr Ross serves as a consultant for twoXAR Pharmaceuticals and Catalys Pacific. DaVita Corp pays the Montefiore Department of Medicine a Medical Director fee for Dr Golestaneh's services as Medical Director of their home dialysis program. The other authors declare that they have no relevant financial interests. We acknowledge the following team members who were instrumental in the implementation of the urgent PD program at MMC: Dr Juan Rocca, Dr Maureen Brogan, Meghan Neubauer, Louis Tingling, Jennie Wilson, Memouna Ousman, Cheryl Fried, Veronica Thompson, Melba Garcia, the Interventional Radiology Department (specifically, Dr. Jacob Cynamon and Dr. Jaron Tepper who were essential in placing PD catheters during the height of the pandemic), the Division of Nephrology and Division of Transplant Nephrology physicians who volunteered their time (in addition to their usual work schedule) and expertise to provide care for PD patients, and all the nurses who participated in provision of PD for MMC patients. We thank you. Received April 26, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from an Associate Editor and a Deputy Editor. Accepted in revised form June 2, 2020.
Publisher Copyright:
© 2020
PY - 2020/9
Y1 - 2020/9
N2 - At Montefiore Medical Center in The Bronx, NY, the first case of coronavirus disease 2019 (COVID-19) was admitted on March 11, 2020. At the height of the pandemic, there were 855 patients with COVID-19 admitted on April 13, 2020. Due to high demand for dialysis and shortages of staff and supplies, we started an urgent peritoneal dialysis (PD) program. From April 1 to April 22, a total of 30 patients were started on PD. Of those 30 patients, 14 died during their hospitalization, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Although the PD program was successful in its ability to provide much-needed kidney replacement therapy when hemodialysis was not available, challenges to delivering adequate PD dosage included difficulties providing nurse training and availability of supplies. Providing adequate clearance and ultrafiltration for patients in intensive care units was especially difficult due to the high prevalence of a hypercatabolic state, volume overload, and prone positioning. PD was more easily performed in non–critically ill patients outside the intensive care unit. Despite these challenges, we demonstrate that urgent PD is a feasible alternative to hemodialysis in situations with critical resource shortages.
AB - At Montefiore Medical Center in The Bronx, NY, the first case of coronavirus disease 2019 (COVID-19) was admitted on March 11, 2020. At the height of the pandemic, there were 855 patients with COVID-19 admitted on April 13, 2020. Due to high demand for dialysis and shortages of staff and supplies, we started an urgent peritoneal dialysis (PD) program. From April 1 to April 22, a total of 30 patients were started on PD. Of those 30 patients, 14 died during their hospitalization, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Although the PD program was successful in its ability to provide much-needed kidney replacement therapy when hemodialysis was not available, challenges to delivering adequate PD dosage included difficulties providing nurse training and availability of supplies. Providing adequate clearance and ultrafiltration for patients in intensive care units was especially difficult due to the high prevalence of a hypercatabolic state, volume overload, and prone positioning. PD was more easily performed in non–critically ill patients outside the intensive care unit. Despite these challenges, we demonstrate that urgent PD is a feasible alternative to hemodialysis in situations with critical resource shortages.
KW - COVID nephropathy
KW - COVID-19
KW - acute care
KW - acute kidney injury (AKI)
KW - acute renal failure (ARF)
KW - continuous renal replacement therapy (CRRT)
KW - coronavirus
KW - dialysis
KW - intensive care unit (ICU)
KW - peritoneal dialysis (PD)
KW - resource allocation
KW - resource shortage
KW - urgent-start PD
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U2 - 10.1053/j.ajkd.2020.06.001
DO - 10.1053/j.ajkd.2020.06.001
M3 - Article
C2 - 32534129
AN - SCOPUS:85087216497
SN - 0272-6386
VL - 76
SP - 401
EP - 406
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -