Introduction
During the Covid19 pandemia (CV19), patient care with RRT has undergone dramatic changes. CV19 lethality in Peritoneal Dialysis (PD) is greater than general population. We present our experience in PD, in changing the attention model and its clinical results.
Methods
In March 2020, we developed a new model of PD patients care. Most of the care was done telemetrically (according to patient availability, email, video calls, whatsap). Emergencies were attended on site (Peritonitis, catheter malfunction). Patient education about CV19 was telemetric through videos, Chilean ministerial and society links. On-site care was performed by one patient at a time, adapting direct attention to patient, waiting rooms and signals, according to regulations. Regular stable patient care was done through structured telecontrols, which includes: Nurse interaction to obtain patient records (Arterial blood pressure, weight, UF rate, diuresis, catheter exit-site, ankle and catheter photos), modem machine cycler telemetric records, nurse records. In stable patients without safe transfer to the PD center, the nephrologist determined whether there was a need for lab tests. Patients with residences away were asked to obtain lab tests in their localities. Nephrological telemetric control was done with these informations.
Results
| TABLE 1ANALYZED PARAMETERS | PRE CV19 (5 months) (mean) | DURING CV19 (5 months) (mean) | p value |
| Number of ON-SITE CONTROLS | 8.6 | 1.7 | <0.05 |
| number of TELEMETRIC CONTROLS | 0.4 | 4.6 | <0.05 |
| ARTERIAL BLOOD PRESSURE (mmHg) | 129/80 | 130/80 | |
| DIURESIS (ml) | 629 | 614 | |
| EDEMA (patients) | 8 | 7 | |
| PERITONEAL UF (ml) | 779 | 771 | |
| Hemoglobin (g/dl) | 10.3 | 10.6 | |
| Potassium (mEq/L) | 4.7 | 4.6 | |
| Phosforous (mg/dl) | 5.6 | 5.6 | |
| iPTH | 680 | 549 | |
| Total Kt/V | 1.9 | 2.0 | |
| Albumin (g/dl) | 3.6 | 3.6 | |
| EPO Dose (units/month) | 18308 | 17922 | |
| Patients with peritonitis | 3 | 4 | |
| Exit Site Infection | 7 | 2 | <0.05 |
| Hospitalization (Days/patient/period) | 0.86 | 0.82 | |
| Weigth (Kg) | 66.3 | 65.7 | |
| Other complications (text) | 15 | 22 | <0.05 |
78 patients in PD were retrospectively analyzed in 2 time ranges. Pre CV19 (Nov 19 to March 20, 5 months) and During CV19 (April 20 to August 20, 5 months). We compared the results of both. The clinical results analyzed in Table 1. Statistical analysis with Chi square and T Student. Average age 51.5 years. During CV19, on-site attentions were significantly reduced, increasing telemetric attentions. Blood pressure, diuresis, edema, UF rate, Hemoglobin, phosphorus, iPTH, Kt/V, Albumin, EPO dosage, hospitalization rate, weight, remained very similar in both periods. 3 patient had Peritonitis in preCV19 period, compared with 4 in CV19 period. 4 patients tested positive for SARS COV2 (5.1%) all community and family acquired, 1 died. Lower rate of ES infection and a higher rate of other complications during CV19 (transient hypotension/hypertension, UF transient failure, all telemetrically well managed) were detected.
Conclusions
Telemetric model of care allows adequate control of patients. The clinical measured parameters, did not suffer changes, remaining stable, comparing the two periods, with on-site compared with telemetric controls. It was observed that 5% suffered CV19. 1 died. Complication rates were similar. The number of patients developed peritonitis and hospitalization rates were no statistically different. The telemetric control model has no clinical differences with on-site results. It could be maintained in the future, combined with on-site attentions, especially in the remote patient.
No conflict of interest