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

  1. Nina J. Caplin
  2. Olga Zhdanova
  3. Manish Tandon
  4. Nathan Thompson
  5. Dhwanil Patel
  6. Qandeel Soomro
  7. Fnu Ranjeeta
  8. Leian Joseph
  9. Jennifer Scherer
  10. Shivam Joshi
  11. Betty Dyal
  12. Harminder Chawla
  13. Sitalakshmi Iyer
  14. Douglas Bails
  15. Judith Benstein
  16. David S. Goldfarb
  17. Bruce Gelb
  18. Richard Amerling
  19. David M. Charytan

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Abstract

The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI.

Methods

Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive–care unit, demonstrating efficacy with outcomes comparable to standard care.

Results

From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position.

Conclusions

Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.

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  1. Version published to 10.34067/kid.0005192020
  2. ScreenIT

    SciScore for 10.1101/2020.08.16.20175992: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We summarize some of the limitations to the use of various modalities in Table 2. Several studies and meta-analyses show PD to be non-inferior to IHD or CVVH.16,17 It also continues to be used widely in children.19–21 Nevertheless, there is a reluctance to use PD to treat adult patients in the ICU in the US. The reasons for this underutilization may be lack of familiarity with the technique by nephrologists, intensivists and nursing staff, and the ease of ordering CVVH by the physicians. Unease about the certainty of UF and clearance potential and misconceptions regarding complications or effectiveness despite many positive trials also contribute.21 We observed a mortality rate of 63% for patients with stage 3 AKI receiving PD, comparable to or less than the mortality reported in other series of COVID patients with stage 3 AKI suggesting that we were able to deliver adequate therapy.5,22,23 Furthermore, we were able to achieve this with a negligible complication rate, which is a tribute to the skill of the surgical team and the scrupulous technique of the PD and nursing staff. Our experience provides a roadmap for responses to future crises with heavy burdens of AKI. It demonstrates that the rapid development of PD capability is a viable alternative to reliance on expanding hemodialysis and CVVH capacity, and can be implemented in centers with minimal prior experience with PD. There are several advantages of this approach. We reduced our reliance on a single source of consuma...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.08.16.20175992v1 on medRxiv