Outcomes of PD for AKI treatment during COVID-19 in New York City: A multicenter study

• Published in: Peritoneal dialysis international 2023-01, Vol.43 (1), p.13-22
• Main Authors: Sourial, Maryanne Y, Gone, Anirudh, Uribarri, Jaime, Srivatana, Vesh, Sharma, Shuchita, Shimonov, Daniil, Chang, Michael, Mowrey, Wenzhu, Dalsan, Rochelle, Sedaliu, Kaltrina, Jain, Swati, Ross, Michael J, Caplin, Nina, Chen, Wei
• Format: Article
• Language: English
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/08968608221130559

Background: The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy). Methods: In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan–Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery. Results: The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27–0.82, p = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery (p = 0.48). Conclusions: The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings. Graphical Abstract This is a visual representation of the abstract.