Use of peritoneal dialysis for the treatment of AKI was associated with lower risk for 30-day all-cause mortality during the COVID-19 surge

Background: To offset resource constraints that limited the capability to deliver hemodialysis (HD) during the COVID-19 surge, nephrologists in New York City (NYC) rapidly incorporated peritoneal dialysis (PD) for the treatment of acute kidney injury (AKI), which was rarely used in the United States. This study aims to compare the in-hospital all-cause mortality between AKI patients who received PD versus HD during the COVID-19 pandemic. Methods: In a retrospective observational study, we collected data on 259 patients with AKI who required kidney replacement therapy (KRT) in four medical centers of NYC during the Spring 2020. Patients who had ever received PD were included in the PD group (n=93), and patients who only received intermittent HD or continuous KRT were included in the HD group (n=166). Kaplan-Meier survival curves, log-rank test and Cox regression were used to compare survival between PD and HD groups. Results: For the entire cohort, the mean age was 61±11 years;31% were women;96% had confirmed COVID-19. Median follow up was 21 days (IQR 12-30). Mortality was lower in PD group compared to HD group (43% vs. 60%, p=0.01). Time-dependent analyses showed that PD group was at a lower risk for mortality compared to HD group (p<0.001 for Log-rank test;Figure). After adjusting for age, sex, BMI, comorbidities, oxygenation on admission, mechanical ventilation, prone positioning, steroid use and C-reactive protein, the PD group remained to have a lower risk of mortality compared to the HD group with a HR of 0.45 (95% CI: 0.27-0.77, p=0.003). Conclusions: Compared to HD, the use of PD for the treatment of AKI was associated with lower mortality in this cohort of patients treated during the COVID-19 pandemic in the Spring of 2020. Our findings demonstrate that rapid implementation of PD for the treatment of AKI was feasible and may be lifesaving.