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

Nina J. Caplin; Olga Zhdanova; Manish Tandon; Nathan Thompson; Dhwanil Patel; Qandeel Soomro; Fnu Ranjeeta; Leian Joseph; Jennifer Scherer; Shivam Joshi; Betty Dyal; Harminder Chawla; Sitalakshmi Iyer; Douglas Bails; Judith Benstein; David S. Goldfarb; Bruce Gelb; Richard Amerling; David M. Charytan

doi:10.34067/KID.0005192020

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

Nina J. Caplin, Olga Zhdanova, Manish Tandon, Nathan Thompson, Dhwanil Patel, Qandeel Soomro, Fnu Ranjeeta, Leian Joseph, Jennifer Scherer, Shivam Joshi, Betty Dyal, Harminder Chawla, Sitalakshmi Iyer, Douglas Bails, Judith Benstein, David S. Goldfarb, Bruce Gelb, Richard Amerling, David M. Charytan

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background 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.

Original language	English
Pages (from-to)	1345-1352
Number of pages	8
Journal	Kidney360
Volume	1
Issue number	12
DOIs	https://doi.org/10.34067/KID.0005192020
State	Published - 1 Dec 2020
Externally published	Yes

Keywords

COVID-19
New York City
acute kidney injury
acute kidney injury and ICU nephrology
continuous kidney replacement therapy
hemodialysis
hospital
intensive care unit
pandemic
peritoneal dialysis
prone ventilation

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10.34067/KID.0005192020

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Caplin, N. J., Zhdanova, O., Tandon, M., Thompson, N., Patel, D., Soomro, Q., Ranjeeta, F., Joseph, L., Scherer, J., Joshi, S., Dyal, B., Chawla, H., Iyer, S., Bails, D., Benstein, J., Goldfarb, D. S., Gelb, B., Amerling, R., & Charytan, D. M. (2020). Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City. Kidney360, 1(12), 1345-1352. https://doi.org/10.34067/KID.0005192020

@article{72df995189ad42cf90f51f90f21ba143,

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

abstract = "Background 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.",

keywords = "COVID-19, New York City, acute kidney injury, acute kidney injury and ICU nephrology, continuous kidney replacement therapy, hemodialysis, hospital, intensive care unit, pandemic, peritoneal dialysis, prone ventilation",

author = "Caplin, {Nina J.} and Olga Zhdanova and Manish Tandon and Nathan Thompson and Dhwanil Patel and Qandeel Soomro and Fnu Ranjeeta and Leian Joseph and Jennifer Scherer and Shivam Joshi and Betty Dyal and Harminder Chawla and Sitalakshmi Iyer and Douglas Bails and Judith Benstein and Goldfarb, {David S.} and Bruce Gelb and Richard Amerling and Charytan, {David M.}",

note = "Publisher Copyright: {\textcopyright} 2020 by the American Society of Nephrology.",

year = "2020",

month = dec,

day = "1",

doi = "10.34067/KID.0005192020",

language = "English",

volume = "1",

pages = "1345--1352",

journal = "Kidney360",

issn = "2641-7650",

publisher = "Lippincott Williams and Wilkins",

number = "12",

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Caplin, NJ, Zhdanova, O, Tandon, M, Thompson, N, Patel, D, Soomro, Q, Ranjeeta, F, Joseph, L, Scherer, J, Joshi, S, Dyal, B, Chawla, H, Iyer, S, Bails, D, Benstein, J, Goldfarb, DS, Gelb, B, Amerling, R & Charytan, DM 2020, 'Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City', Kidney360, vol. 1, no. 12, pp. 1345-1352. https://doi.org/10.34067/KID.0005192020

TY - JOUR

T1 - Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

AU - Caplin, Nina J.

AU - Zhdanova, Olga

AU - Tandon, Manish

AU - Thompson, Nathan

AU - Patel, Dhwanil

AU - Soomro, Qandeel

AU - Ranjeeta, Fnu

AU - Joseph, Leian

AU - Scherer, Jennifer

AU - Joshi, Shivam

AU - Dyal, Betty

AU - Chawla, Harminder

AU - Iyer, Sitalakshmi

AU - Bails, Douglas

AU - Benstein, Judith

AU - Goldfarb, David S.

AU - Gelb, Bruce

AU - Amerling, Richard

AU - Charytan, David M.

PY - 2020/12/1

Y1 - 2020/12/1

N2 - Background 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.

AB - Background 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.

KW - COVID-19

KW - New York City

KW - acute kidney injury

KW - acute kidney injury and ICU nephrology

KW - continuous kidney replacement therapy

KW - hemodialysis

KW - hospital

KW - intensive care unit

KW - pandemic

KW - peritoneal dialysis

KW - prone ventilation

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DO - 10.34067/KID.0005192020

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JO - Kidney360

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ER -

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

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