Awareness and Knowledge Among Internal Medicine House-Staff for Dose Adjustment of Cardiovascular Drugs in Chronic Kidney Disease.

INTRODUCTION: Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs. AIM: To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS). METHODS: Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted. RESULTS: We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19-14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37-10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10-0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21-0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16-0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12-0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10-3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11-0.82, p < 0.05). CONCLUSIONS: IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.

Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City.

Background: The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI. Methods: Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive-care unit, demonstrating efficacy with outcomes comparable to standard care. Results: From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions: Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.