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CLINICAL PRACTICE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 33-34

Peritoneal dialysis practice during the Coronavirus 2019 pandemic


Senior Consultant and Head, Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Submission05-Aug-2020
Date of Acceptance13-Aug-2020
Date of Web Publication01-Sep-2020

Correspondence Address:
Dr. K C Prakash
Apollo Hospitals, 21, Greams Lane, Off Greams Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_16_20

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  Abstract 


During COVID-19 pandemic. the practice of peritoneal dialysis is better understood as dealing with behaviour, management, and prevention of infection in end-stage-renal-disease. Adequate supplies should be stocked for at least 2 to 3 weeks in case of quarantine or break in supply chain due to transport breakdown. This article briefly covers acute PD in COVID patients with acute kidney injury (AKI) stable PD patients in pandemic (not infected) an PD patients with COVID infection.

Keywords: Chronic kidney disease, COVID-19, peritoneal dialysis


How to cite this article:
Prakash K C. Peritoneal dialysis practice during the Coronavirus 2019 pandemic. J Renal Nutr Metab 2020;6:33-4

How to cite this URL:
Prakash K C. Peritoneal dialysis practice during the Coronavirus 2019 pandemic. J Renal Nutr Metab [serial online] 2020 [cited 2020 Sep 21];6:33-4. Available from: http://www.jrnm.in/text.asp?2020/6/2/33/294182




  Introduction Top


The global pandemic caused by a virus known as coronavirus 2019 (COVID-19) is causing major health problems and economic setback across the world. This has exposed health-care deficiencies in almost all countries. This disease being highly infective is associated with high mortality in patients with comorbid conditions. Chronic kidney disease Stage 5 (CKD 5D) patients on dialysis are vulnerable as most of them have comorbidities such as diabetes, hypertension, immunosuppressed state, underlying cardiac disease, and repeated exposure to hospital environment. The patients with CKD 5 can opt either for hemodialysis (HD) or peritoneal dialysis (PD) if found suitable.

HD patients in India prefer institutional dialysis and hence most of them are dialyzed in hospital or in satellite centers. This is carried out either three times or two times a week. This means the patient has to travel two to three times a week to hospital and have to mingle with other patients. This leads to increased chance of transmission of infection among not only in between patients but other dialysis personnel.


  Peritoneal Dialysis in Pandemic Top


This topic can be broadly classified as:

  1. Acute PD in COVID patients with acute kidney injury (AKI)
  2. Stable PD patients in pandemic (not infected)
  3. PD patients with COVID infection.


Acute peritoneal dialysis in COVID patients with acute kidney injury

More than 5% of patients in COVID critical care unit have renal insufficiency requiring some form of renal replacement therapy (RRT). As many patients are in respiratory distress or on some form of ventilator support, increased intra-abdominal pressure caused by PD fluid can cause inadequate ventilation and can be hindrance.[1],[2],[3],[4] Hypercatabolic state and ineffective desired fluid removal in these patients can also render PD ineffective in some. However, some centers in Europe and the USA have attempted PD in limited numbers with frequent small-volume exchanges or with tidal volume. No outcome study has been carried out. This can be reserved where facilities for continuous RRT is not available and of very limited use for the present time. However, PD can be considered in stable COVID patients with AKI.

Stable peritoneal dialysis in pandemic

Initiation of PD in pandemic – surgical insertion of catheter – should not be viewed as a routine surgery and should be planned in non-COVID place where the staff are regularly screened for possible infection. If experienced, medical insertion of catheter can be planned as it can be done under local anesthesia and does not require hospitalization.[4]

Stable PD patients should stay at home except in emergency conditions. Like general public, they and their family members should practice social distancing, wearing mask, hand hygiene, etc., Regular consultation can be carried out through telecommunication and hospital visits should be done only if absolutely necessary. Home visits by health-care workers should be avoided or minimized with full precautions.

PD patients or their relatives are adequately trained to perform the procedure at home. This gives an advantage of avoiding hospital visits, thereby reducing exposure to infection. These patients can continue the procedure in the usual way in a dedicated room. It is better to avoid caregivers, and instead self or a close family member can assist in performing the procedure. The patients and the assistants are usually well trained regarding aseptic techniques such as hand washing with soap, wearing mask, gloves, and use of alcohol disinfectant. Personal protective equipment should be used by the assistant only if the patient is COVID positive or a suspected case pending investigation. Routine testing such as peritoneal equilibration test (PET) and creatinine clearance should be avoided unless if absolutely indicated, thereby reducing hospital visits.

All patients visiting the PD clinic should be screened for the possibility of infection or exposure. The screening consists of questioning for symptoms such as fever, cough, body pain, myalgia, breathlessness, and loss of taste and smell. History of travel to prevalent places or contact with infected persons should be recorded. If the patient is suspected to have possible infection, then he/she should be referred to the COVID care unit. If the patient requires admission and treatment for PD-related problems, then he/she should be treated with appropriate infection control measures with experienced staff in COVID inpatient area.

Adequate supplies should be stocked for at least 2 to 3 weeks in case of quarantine or break in supply chain due to transport breakdown.

PD fluid disposal – It is not demonstrated whether or not that the virus is present in PD fluid in COVID-19-infected patients. Hence, it is better to assume that the virus may be present and adequate precaution should be taken while disposing fluid and accessories such as wearing gloves, gown, and eye shield. The fluid should be gently poured in the toilet bowl avoiding splash. Bleach is an accepted and effective disinfectant for COVID-19. It is recommended in 1:10 dilution. It can be poured in the toilet bowl after disposing PD fluid and kept for 5–10 min before flushing. Used PD bags and tubings should be carefully sealed in a plastic cover. One can have double packing with an additional plastic bag.

Peritoneal dialysis patients with COVID infection

The patient as in other cases has to be isolated either in hospital or at home depending on severity. PD can be continued by self or trained personnel with adequate protection if the patient is stable. If the patient requires respiratory support or in respiratory distress, then one may have to consider switching over to other forms of renal replacement treatment which has an added advantage of fluid removal.

In the due period as COVID-19 is better understood regarding its behavior, management, and prevention, PD definitely will find its place in the management of AKI and CKD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
  References Top

1.
Nagatomo M, Yamada H, Shinozuka K, Shimoto M, Yunoki T, Ohtsuru S, et al. Peritoneal dialysis for COVID-19-associated acute kidney injury. Crit Care 2020;24:309.  Back to cited text no. 1
    
2.
Guidelines for Dialysis with reference to COVID-19 Infection Government of India Ministry of Health & Family Welfare (MoHFW–) Guidelines for Dialysis of COVID – 19 patients. Published 2020.  Back to cited text no. 2
    
3.
Shamy OE, Patel N, Baset MH, et al. Acute Start Peritoneal Dialysis during the COVID-19 Pandemic: Outcomes and Experiences J Am Soc Nephrol 2020;31:1680-82.  Back to cited text no. 3
    
4.
Jeloka T, Gupta A, Prasad N, Varughese S, Mahajan S, Nayak K S, et al. On behalf of COVID-19 working group of Indian society of nephrology. Peritoneal dialysis patients during COVID-19 pandemic. Indian J of Nephrol 2020;30:171-3.  Back to cited text no. 4
    




 

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