TEMPORAL ASSOCIATION OF PERITONEAL DIALYSIS PERITONITIS RATES AND OUTCOMES WITH COVID-19 PANDEMIC ONSET IN AUSTRALIA: A REGISTRY ANALYSIS
ARUNIMA JAIN1,2, ERIC AU3,4,5, SRADHA KOTWAL1,2,6, DAVID JOHNSON7,8,9,10, KAMAL SUD11,12, MONIQUE BORLACE13, ASHIK HAYAT7,8,9,10, KATRINA CHAU14,15, MELINDA TOMLINS16, JENNY CHEN17,18, NEIL BOUDVILLE19,20
1Department of Nephrology, Prince Of Wales Hospital, Sydney, Australia, 2School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia, 3Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), , Australia, 4Department of Renal Medicine, Alfred Hospital, Melbourne, Australia, 5University of Melbourne, Melbourne, Australia, 6The George Institute for Global Health, Sydney, Australia, 7Department of Kidney and Transplant Services, Princess Alexandria Hospital, Brisbane, Australia, 8Centre for Health Services Research, University of Queensland, Brisbane, Australia, 9Translational Research Institute, Brisbane, Australia, 10Australasian Kidney Trials Network, Brisbane, Australia, 11Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, Australia, 12Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 13Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, Australia, 14Western Renal Service, Blacktown Hospital, Sydney, Australia, 15Blacktown Clinical School, School of Medicine, Western Sydney University, Sydney, Australia, 16Department of Nephrology, John Hunter Hospital, Newcastle, Australia, 17Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 18School of Medicine, University of Wollongong, Wollongong, Australia, 19Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia, 20Medical School, University of Western Australia, Perth, Australia
Aim: To compare peritoneal dialysis (PD) peritonitis rates and outcomes before and after COVID-19 pandemic onset in Australia. A secondary objective was comparison of incident PD patient characteristics.
Background: Effective hand hygiene is recommended to prevent PD-peritonitis. It is unclear whether the COVID-19 pandemic and ensuing self-reported improvements in hand hygiene were associated with improved PD-peritonitis rates and outcomes.
Methods: The study included patients on PD in Australia between 1/1/2015 and 31/12/2022, as recorded by the Australia and New Zealand Dialysis and Transplant Registry. PD-peritonitis rates and outcomes were analysed before COVID-19 onset (1/1/2015 – 10/3/2020) and after COVID-19 onset (11/3/2020 – 31/12/2022). COVID-19 onset was defined using the WHO worldwide pandemic date (11/3/2020). Characteristics of incident patients commencing PD before and after COVID-19 onset were also analysed.
Results: Of 11,499 patients who received PD, 3236 patients (28.1%) commenced PD after COVID-19 onset and 8263 (71.9%) before. Compared with the pre-COVID-19 era, the post-COVID-19 era was associated with lower peritonitis rates (0.30 [95% CI 0.29-0.31] vs 0.35 person-years [95% CI 0.34-0.36]; p<0.001), fewer PD-peritonitis-related hospital admissions (67.1% vs 71.5%, p<0.001), fewer PD-peritonitis-related PD catheter removals (16.3% vs 20.5%, p<0.001) and fewer PD-peritonitis-related haemodialysis transfers (13.1% vs 17.6%, p<0.001).
There was no difference in: age at dialysis initiation (median 60 years [IQR 47-70] vs 60 [IQR 47-70], p=0.59), diabetes (44.8% vs 46.1%, p=0.23), cardiovascular (27.3% vs 28.1%, p=0.46) or lung disease (10.4% vs 11.5%, p=0.13) in incident patients after COVID-19 onset compared with the pre-COVID-19 cohort.
Conclusions: Onset of COVID-19 was associated with improved PD-peritonitis rates and outcomes in Australia, with no difference in age at dialysis initiation and diagnoses of diabetes, cardiovascular or lung disease.
Biography:
Dr Arunima Jain is an early career Nephrologist, currently dual training in Obstetric Medicine at the Royal Hospital for Women in Sydney. She has been awarded a NHMRC Postgraduate Scholarship to pursue her PhD next year through the University of New South Wales, in collaboration with a multidisciplinary team. Her research will focus on improving diagnosis and management of kidney disease in and beyond pregnancy. Additional clinical and research areas of interest include hypertension and peritoneal dialysis.