ABSTRACT
INTRODUCTION: Acute kidney injury (AKI) is strongly associated with poor prognosis of Coronavirus disease 2019 (COVID-19) patients. The great pandemic made it challenging to allocate renal replacement therapy (RRT) such as hemodialysis or continuous hemodiafiltration to anuria patients in terms of infection control and medical resources. Herein, using an actual case, we argue that peritoneal dialysis (PD) could become a more practical and safer RRT, particularly during this pandemic crisis. METHODS: Our case was a 62-year-old male with a PCR test positive for severe acute respiratory syndrome coronavirus (SARS-CoV-2). He had a medical history of lung cancer and some commodities of hypertension, hyperuricemia, and hyperlipidemia. The next day after the admission, his oxygenation and hemodynamics rapidly deteriorated. We started mechanical ventilation, and administered vasopressors, favipiravir, and ciclesonide. Additionally, serum creatinine also became gradually elevated (creatinine: day1 0.77 mg/dL → day5 7 mg/dL). We diagnosed with COVID-19-associated AKI, because urine tests and sonography did not indicate any other cause. It progressed to anuria and made it difficult to control the serum potassium and the hemodynamics due to acidemia. On day 6, using a portable X-ray machine, we inserted the peritoneal dialysis (PD) catheter to the recto-vesical pouch at the bedside and infused the peritoneal dialysate. Although the anuria persisted for a while, the increased amount of peritoneal dialysate easily normalized the acidemia and serum potassium level. After the normalization, the vasopressors could be tapered off, and the inflammation status was also improved. On day 14, the patient was discharged from our ICU with the PD catheter. SARS-CoV-2 was detectable in sputum, but not in the peritoneum and PD waste. The whole procedure of PD catheter insertion and dialysate exchange did not influence the respiratory status and hemodynamics at any time. RESULTS: Taken together, PD could be a useful option for the AKI management, particularly in the COVID-19 pandemics.