key: cord-0969497-rvvzl6y1 authors: Chen, Tz‐Heng; Wen, Yu‐Hua; Chen, Chun‐Fan; Tan, Ann Charis; Chen, Yung‐Tai; Chen, Fan‐Yu; Lin, Chih‐Ching title: The advantages of peritoneal dialysis over hemodialysis during the COVID‐19 pandemic date: 2020-07-16 journal: Semin Dial DOI: 10.1111/sdi.12903 sha: b1245e89c6ae936b1817c999150cd713eb632784 doc_id: 969497 cord_uid: rvvzl6y1 nan The outbreak of the coronavirus disease 2019 (COVID-19) since the end of 2019 has had a considerable impact on the global economy and also on the healthcare system. The mismatch of supply and demand in medical resources worldwide, such as masks and protective gowns, has put healthcare workers and patients at a high risk of exposure to infection. This crisis has now become a major challenge particularly to patients undergoing chronic hemodialysis (HD). HD patients stay in the same space with many other patients and healthcare workers two to three times per week for dialysis treatments that can last for 3-4 hours. In the face of the COVID-19 pandemic, infection clusters can easily occur in the HD unit. Even if the US Centers for Disease Control and Prevention already provided relevant suggestions for infection prevention and control, these patients are still exposed to considerable risks for infection. Patient with confirmed COVID-19 can be asymptomatic, therefore maintaining social distancing is important. However, during the cannulation process for HD, the nurses must be in close contact with multiple patients. It may become a weak spot in the prevention of virus spreading, especially during the shortage of masks worldwide. Moreover, a very high proportion of dialysis patients are the elderly or patients with multiple comorbidities. Once infected with COVID-19, these patients will have higher risks for morbidity and mortality. Patients with suspected or confirmed COVID-19 in outpatient HD facilities may have to be triaged to a hospital with isolation wards for dialysis, resulting in a shortage of dialysis machines, dialysates, wards, and healthcare workers. In response to this problem, experts may even need to recommend reducing the patient's dialysis frequency and duration and decreasing the dialysate flow rate to a maximum of 600 mL/min to increase the HD surge capacity. During the COVID-19 pandemic where most of the medical attention is focused on treating infected patients, HD treatments in a hospital not only consumes a large amount of medical resources, but also compromises the healthcare services for patients with non-COVID-related diseases. In addition to the need for high volumes of clean dialysate, machines, circuits, and spaces, HD requires a large number of healthcare workers such as physicians, nurses, technicians, and janitors. However, the number of such healthcare workers may be reduced due to illness or quarantine. They may also be infected while serving HD patients, resulting in a shortage of dialysis care team members. In the era of the COVID-19 pandemic, maintaining adequate dialysis workforce is challenging. For patients with suspected or confirmed COVID-19, they can also be isolated at home without occupying the isolation ward for dialysis. Home HD is also a dialysis modality that can prevent infection clusters and preserve the healthcare workforce. However, the prevalence of home HD in most developing countries is still quite low today. This may be due to expensive dialysis equipment, a more complex training program, and lack of patient motivation. Moreover, home HD requires a high volume of clean water, which may be difficult to conduct in areas with poor water quality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly invades the lower respiratory tract, resulting in diffused alveolar damage and respiratory symptoms. 1 Studies have found that about 30% of patients with COVID-19 had dyspnea. 2 The primary findings on the chest computed tomography scan include bilateral ground-glass opacity or consolidation. 3 The need for frequent HD unit visits and patient clustering increase the risk of virus spreading Low risk of PD solution shortage The need for a large number of healthcare workers, protective equipment, clean water, dialysis machines, which may be lacking in COVID-like pandemic or epidemic No need for healthcare workers Healthcare workers may be reduced due to illness or quarantine, resulting in a shortage in the workforce Gentle and prolonged removal of body fluids and toxins during PD reduces the risk of hemodynamic instability in infected patients Faster removal of toxins and fluids than PD, causing a higher risk of hemodynamic instability Respiratory symptoms PD removes fluids more continuously than HD, which minimizes risk of hypervolemia; however, the intraperitoneal fluid instillation may increase intraperitoneal pressure and may compromise pulmonary function Fluid accumulation can easily occur in intermittent HD, which may worsen oxygenation In conclusion, PD offers several advantages over HD, especially in the issue of public health and infection control in the current COVID-19 pandemic. Furthermore, AKI is a crucial complication of COVID-19 in addition to cardiopulmonary injury and whether the risk of chronic kidney disease will increase after this pandemic is still unknown. 13 When inpatient HD units become a resource-constrained environment, alternative therapeutic strategies for dialysis patients should be considered. Thus the role of PD will be more important for ESRD patients from now on, not only in the current pandemic but also in any outbreak of other life-threatening infection in the future. The authors declare no conflict of interest. Tz-Heng Chen https://orcid.org/0000-0003-4101-8824 Pathological findings of COVID-19 associated with acute respiratory distress syndrome Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study Management of critically ill adults with COVID-19 Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19) COVID-19 and the cardiovascular system Cardiovascular implications of fatal outcomes of patients with coronavirus disease Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan Clinical characteristics of Covid-19 in New York City Acute kidney injury in critically ill patients: a prospective randomized study of tidal peritoneal dialysis versus continuous renal replacement therapy High volume peritoneal dialysis vs daily hemodialysis: a randomized, controlled trial in patients with acute kidney injury Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome