Utilization of peritoneal dialysis for ventilated COVID-19 patients with acute kidney injury

Background

Peritoneal dialysis for acute kidney injury is not typically a first-line option for mechanically ventilated patients in the intensive care unit. This series investigates the technical feasibility and clinical implications of bedside peritoneal dialysis catheter placement and utilization for mechanically ventilated COVID-19 patients.

Methods

Patient data was retrospectively collected on patient characteristics, hospital course, fluid balance, ventilatory mechanics and associated morbidity and mortality of qualifying patients at a single center from March to April of 2020. Peritoneal dialysis catheters were inserted at bedside in the ICU for use as the primary modality of renal replacement therapy. Ventilatory mechanics were obtained prior to catheter insertion and after the first dwell. Statistics were calculated using GraphPad Prism and Excel.

Results

Seven male ventilated patients ages 52–83 were included. They were primarily Hispanic (71.43%). Comorbidities included chronic kidney disease (14.29%), hypertension (57.14%), hyperlipidemia (42.86%), and diabetes (28.57%). There were no mortalities associated the procedure. All-cause mortality at the time of data collection was 42.8%. Two patients had delayed initiation of peritoneal dialysis due to bleeding. Ventilatory mechanics before and after the first dwell did not demonstrate a significant difference in required FiO₂, PEEP, tidal volumes or PaO₂ to FiO₂ ratios (p = 0.9172, p = 0.7398, p = 0.0924, p = 0.7227).

Discussion

Bedside placement of catheters was performed quickly and safely. Peritoneal dialysis was utilized for the treatment of acute kidney injury in mechanically ventilated patients with COVID-19 without significantly impacting respiratory mechanics. Peritoneal dialysis should be considered for similar ICU patients needing renal replacement therapy.