Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report

Abstract

The kidneys is the most commonly injured organs in sepsis, which might manifest as acute kidney injury (AKI). Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy (RRT), especially in the developing countries. Furthermore, the COVID-19 pandemic has made hemodialysis (HD) unavailable due to infection concerns. We present a critically-ill 16-year-old male with morbid obesity (BMI 43.3 kg/m2), diabetic ketoacidosis, acute pancreatitis, acute kidney injury, and COVID-19 pneumonia. The patient looked somnolent on admission with very high random blood glucose and hypernatremia. Blood gas analysis showed metabolic acidosis. The patient was treated with 1 g/day Meropenem, 0.5 µg/kg/min norepinephrine, 0.04 unit/kg/h vasopressin, and correction of electrolyte imbalance and metabolic acidosis. After 48 h, the diuresis and the creatinine levels worsened. We placed a Tenckhoff catheter and started PD. The patient showed improvement after 72 h of peritoneal dialysis. This case report highlighted the use of PD as a modality of RRT in sepsis-induced AKI, multi-organ failure, and COVID-19. Although it remains controversial, we observed an improvement in diuresis and creatinine levels following PD. PD is more cost-effective and provides a similar outcome compared to other modalities. Abbreviations: AKI - Acute Kidney Injury; BMI- Body Mass Index; CRRT- Continous Renal Replacement Therapu; GCS-Glasgow Coma Scale; HD- Hemodialysis; ICU- Intensive Care Unit; PD- Peritoenal Dialysis; RRT- Renal Replacement Therapy; S-AKI- Sepsis-Associated Acute Kidney Injury; SIRS- Systemic Inflammatory Response Syndrome.