Coronavirus Disease 2019 (COVID-19) Hospitalized Patients with Acute Kidney Injury Treated with Acute Peritoneal Dialysis Do Not Have Infectious Peritoneal Dialysis Effluent.

Acute peritoneal dialysis (PD) has been used in coronavirus disease 2019 (COVID-19) as an alternative to intermittent hemodialysis or continuous renal replacement therapy to mitigate the overwhelming demand for dialysis.1Srivatana V. Aggarwal V. Finkelstein F.O. et al.Peritoneal dialysis for acute kidney injury treatment in the United States: brought to you by the COVID-19 pandemic.Kidney360. 2020; 1: 410-415Crossref PubMed Scopus (32) Google Scholar,2El Shamy O. Sharma S. Winston J. Uribarri J. Peritoneal dialysis during the coronavirus 2019 (COVID-19) pandemic: acute inpatient and maintenance outpatient experiences.Kidney Med. 2020; 2: 377-380Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Liters of PD effluent are discarded in the sewerage system on a daily basis by both patients and medical institutions performing PD. Detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the peritoneal waste of a COVID-19 infected patient with end-stage kidney disease was previously reported.3Vischini G. D'Alonzo S. Grandaliano G. D'Ascenzo F.M. SARS-CoV-2 in the peritoneal waste in a patient treated with peritoneal dialysis.Kidney Int. 2020; 98: 237-238Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Given the uncertainty regarding the risk for viral transmission through the handling of PD effluent of patients with confirmed COVID-19 infections, we set out to determine the presence and infectivity of the SARS-CoV-2 virus in the PD effluent of 10 admitted patients with severe COVID-19 pneumonia (Table 1) treated with acute PD.Table 1Patient demographics, characteristics, and serum levels of selected markers of renal function and inflammationCharacteristicsResultAge (yr)60 ± 9Weight (kg)98.9 ± 25Body mass index (kg/m2)34.5 ± 8.8Race (%) African American70 White10Ethnicity: Hispanic (%)20Serum laboratory testResultLaboratory normal rangeCreatinine (mg/dl)9.0 (IQR, 5.8–14.0)0.7–1.3Blood urea nitrogen (mg/dl)114 (IQR, 97.75–131.5)6–23D-dimer (μg/ml)8.5 (IQR, 3.0–13.1)0–0.5Interleukin-6 (pg/ml)414.4 (IQR, 31.4–594.5)0–5Interleukin-8 (pg/ml)126.9 (IQR, 53.6–221.0)0–5Tumor necrosis factor-α (pg/ml)76.2 (IQR, 30.9–80.3)0–22C-reactive protein (mg/l)228.5 (IQR, 113.8–415.2)0–5IQR, interquartile range. Open table in a new tab IQR, interquartile range. Despite rigorous testing, we could not detect presence of the SARS-CoV-2 virus in the PD effluent. Using control samples, the limit of detection of the quantitative reverse transcription polymerase chain reaction was 1–5 copies of RNA or infectious viral particles per reaction. This test is as sensitive as the accepted US Food and Drug Administration–approved panel (limit of detection: 5 copies/reaction of quantified RNA transcripts).4Lu X. Wang L. Sakthivel S.K. et al.US CDC real-time reverse transcription PCR panel for detection of severe acute respiratory syndrome coronavirus 2.Emerg Infect Dis. 2020; 26: 1654-1665Crossref PubMed Scopus (392) Google Scholar We also determined an absence of infective particles with no cytopathogenic effects seen after a week of monitoring of cell cultures in cell fractions and supernatants recovered from PD effluent, and a lack of plaque formation. Our study demonstrates that the risk of transmission of the virus through PD effluent is low, with an absence of infective viral particles and undetectable viral RNA. These are significant findings for potential future COVID-19 outbreaks and infection control.