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Acute Peritoneal Dialysis With Percutaneous Catheter Insertion for COVID-19-Associated Acute Kidney Injury in Intensive Care: Experience From a UK Tertiary Center. | LitMetric

AI Article Synopsis

  • The COVID-19 pandemic saw increased rates of acute kidney injury (AKI) in critically ill patients, raising the need for renal replacement therapy (RRT), particularly challenging due to the high demand in ICUs.
  • The study evaluated the safety and efficacy of peritoneal dialysis (PD) as an alternative to continuous renal replacement therapy (CRRT) by analyzing catheter insertion and patient outcomes.
  • Results showed successful catheter insertions with no reported complications, stable patient conditions post-insertion, and a median 94.6% RRT coverage through PD, indicating it as a viable option for managing AKI in ventilated COVID-19 patients.

Article Abstract

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to an increased demand for renal replacement therapy (RRT). Providing RRT for this large number of patients is proving challenging, and so alternatives to continuous renal replacement therapies (CRRT) in the intensive care unit (ICU) are needed. 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 sought to describe our recent experience with percutaneous catheter insertion and peritoneal dialysis in patients in the ICU with COVID-19 infection.

Method: Patients were selected according to local protocol, and catheters were inserted percutaneously by experienced operators using a Seldinger technique. Sequential Organ Failure Assessment (SOFA) score and ventilation requirements were recorded at the time of insertion and 24 hours later. Procedural complications, proportion of RRT provided by PD, renal recovery, and RRT parameters (serum potassium and maximum base excess) during PD were assessed.

Results: Percutaneous PD catheters were successfully inserted in 37 of 44 patients (84.1%) after a median of 13.5 days (interquartile range [IQR] = 10.0, 20.3 days) in the ICU. No adverse events were reported; SOFA scores and ventilation requirements were comparable before and after insertion; and adequate RRT parameters were achieved. The median proportion of RRT provided by PD following catheter insertion was 94.6% (IQR = 75.0, 100%).

Conclusion: Peritoneal dialysis provides a safe and effective alternative to CRRT in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836882PMC
http://dx.doi.org/10.1016/j.ekir.2020.11.038DOI Listing

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