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.
ABSTRACT
Background: Telestroke network can provide rapid access to specialized treatment and improves on-site management of acute stroke patients through the “hub-and-spoke” model. In the northern part of Okayama Prefecture, there has been a regional gap of stroke care due to the shortage of stroke specialists and facilities. In addition, due to the novel coronavirus disease 2019 (COVID-19), it is required to reduce the unnecessary contact with stroke patients from other hospitals. Aim: We organized a novel cost-free telestroke network with an image and video sharing for neurological diseases in the northern part of Okayama Prefecture to improve the stroke management in the area. Method: We prepared the tablet device on which Skype® application was installed for each hospital and recruited the patients who visited or hospitalized in the spoke hospitals and were suspected to have some neurological diseases from April 2019 to May 2020. The patient's clinical data were recorded and analyzed. Results: During the study period, 5 patients were recruited including the cases with the initial diagnosis of stroke or brain tumor. Among them, 2 cases were transferred to the hub hospital, 2 cases were transferred to other hospitals, and 1 case was treated on site under specialist's advice. Conclusion: The new telestroke network system may be beneficial for acute stroke management and reducing the unnecessary patient's transfer in the rural area, especially under coexistence with COVID-19.