Acute peritoneal dialysis in obese patients during the COVID-19 pandemic

Background: Due to increased risk for infection, fluid leak, metabolic complications and poor uremic solute clearance, concerns have been raised in using peritoneal dialysis in obese patients However, due to unprecedented need for renal replacement therapy (RRT) in New York City during the COVID-19 pandemic, acute peritoneal dialysis (APD) was initiated in patients regardless of body mass index (BMI) Methods: 36 patients who received PD between April 8, 2020 and May 8,2020 were categorized into 3 groups based on BMI calculated using admission height and weight Group 1 with BMI 40 kg/ m2 Treatment goals included correction of hyperkalemia, hyperphosphatemia, acid-base abnormalities, reduction in blood urea nitrogen (BUN), creatinine and maintaining euvolemia All patients were initially started on manual exchanges every 1-2 hours (Total volume 10-13L/24 hours) and eventually most were changed to automated PD (Total volume 18-20L/24 hours) We compared the frequency of treatment-related complications among the groups Results: Of the 36 patients, 13 had BMI 40, one of whom had BMI > 50 kg/ m2 Patients showed improvement in serum creatinine, BUN, phosphorus, potassium, and bicarbonate All had adequate ultrafiltration and improved volume status after optimization of PD prescription No differences were observed between groups in achievement of treatment goals No patients in any group required discontinuation of PD because of treatment-related complications or insufficient dialysis Conclusions: Acute PD was successfully performed in obese, and morbidly obese patients during the COVID-19 pandemic Treatment goals were achieved based on relevant parameters and there were no increases of treatment related complications compared to non-obese patients Acute PD should not be restricted based on elevated BMI