Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY, USA.
Division of Nephrology, Montefiore Medical Center, Bronx, NY, USA.
Perit Dial Int. 2023 Jan;43(1):13-22. doi: 10.1177/08968608221130559. Epub 2022 Nov 1.
The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy).
In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan-Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery.
The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27-0.82, = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery ( = 0.48).
The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings.
与 COVID-19 相关的急性肾损伤（AKI）发病率高，需要透析，这导致腹膜透析（PD）用于 AKI 的治疗。本研究旨在比较 COVID-19 大流行期间在纽约市接受急性 PD 与体外透析（间歇性血液透析和连续肾脏替代治疗）治疗的 AKI 患者的住院全因死亡率和肾脏恢复情况。
在一项回顾性观察研究中，纳入了 2020 年春季 COVID-19 疫情期间在纽约市需要透析的 259 例 AKI 患者，我们比较了在任何时间点接受急性 PD 的 93 例患者和仅接受体外透析的 166 例患者的 30 天全因死亡率和肾脏恢复情况。Kaplan-Meier 曲线、对数秩检验和 Cox 回归用于比较生存情况，Logistic 回归用于比较肾脏恢复情况。
患者的平均年龄为 61 ± 11 岁；31%为女性；96%的患者确诊 COVID-19，中位随访时间为 21 天。在调整了人口统计学、合并症、开始透析前的氧合和实验室值后，与体外透析相比，PD 的使用与死亡率降低相关，风险比为 0.48（95%置信区间：0.27-0.82， = 0.008）。在出院或住院第 30 天，透析方式与肾脏恢复之间没有关联（ = 0.48）。
与 COVID-19 大流行期间在纽约市使用体外透析相比，PD 用于治疗 AKI 与临床结局恶化无关。鉴于我们的观察性研究中存在固有的选择偏倚和残留混杂因素，需要在更受控的环境中对更大队列的患者进行研究以证实我们的发现。
