Acute Intermittent Peritoneal Dialysis in Critically Ill COVID-19 Patients with Renal Failure: Saviour or Succourer

Benoy Varghese1, Arul Rajagopalan1, Jegan Arunachalam1, *, Arun Prasath1, Rakesh Durai1
1 Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India

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© 2022 Varghese et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India; Tel: +919994373260; E-mail:



The COVID-19 pandemic has led to an increase in critically ill patients with renal failure, with many requiring renal replacement therapies. Unfortunately, many of them are too critically ill to tolerate intermittent hemodialysis. In the setting of limited resources, we did bedside acute intermittent peritoneal dialysis for critically ill COVID-19 patients with hemodynamic instability with or without ventilator support admitted to our intensive care unit.


The aim of the study was to determine the outcome of intermittent peritoneal dialysis in critically ill COVID-19 patients.


Our retrospective observational study included 91 patients with critically ill SARS-CoV2 infection and renal failure admitted to the intensive care unit of our hospital from July 2020 to September 2021, who underwent acute intermittent peritoneal dialysis.


The demographic, laboratory, and treatment parameters were compared between survivors and non-survivors. Variables, like increased mean age (49.88 vs. 59.07 years), presence of diabetes mellitus (36.4% vs. 63.8%), increased lung involvement (57.3% vs. 75.0%), mechanical ventilation (15.2% vs. 70.7%), systolic (84.3 vs. 77.5 mm of Hg) and diastolic (59.09 vs. 42.93 mm of Hg) blood pressures, were associated with poor outcomes. The use of hypertonic PD (63.6% vs. 37.9%), better urea reduction ratios (44.33 vs. 39.84), and increased PD cycles (66.52 vs. 44.26) were associated with a better outcome. Complications, like haemorrhage and peritonitis, occurred in 10.9%.


PD is a cost-effective bedside RRT that can be considered an effective option in critically ill COVID-19 patients. Good urea clearance, hemodynamic stability, and minimal resource requirements are also the features that favour peritoneal dialysis.

Keywords: Critically ill, COVID-19, Hemodynamic instability, Acute intermittent peritoneal dialysis, Urea reduction ratio, Peritoneal dialysis cycles.