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Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic.
Am J Kidney Dis. 2020 09; 76(3):392-400.AJ

Abstract

With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: horng_ruey_chua@nuhs.edu.sg.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, Singapore.Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.Department of Renal Medicine, Changi General Hospital, Singapore.Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.Department of Renal Medicine, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.Duke-NUS Medical School, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.Duke-NUS Medical School, Singapore; Department of Surgical Intensive Care, Singapore General Hospital, Singapore.Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Anaesthesia, National University Hospital, Singapore.Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Division of Renal Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore.Division of Renal Medicine, Department of Medicine, Sengkang General Hospital, Singapore.Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore.Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore.Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore. Electronic address: manish.kaushik@singhealth.com.sg.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32505811

Citation

Chua, Horng-Ruey, et al. "Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 76, no. 3, 2020, pp. 392-400.
Chua HR, MacLaren G, Choong LH, et al. Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic. Am J Kidney Dis. 2020;76(3):392-400.
Chua, H. R., MacLaren, G., Choong, L. H., Chionh, C. Y., Khoo, B. Z. E., Yeo, S. C., Sewa, D. W., Ng, S. Y., Choo, J. C., Teo, B. W., Tan, H. K., Siow, W. T., Agrawal, R. V., Tan, C. S., Vathsala, A., Tagore, R., Seow, T. Y., Khatri, P., Hong, W. Z., & Kaushik, M. (2020). Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 76(3), 392-400. https://doi.org/10.1053/j.ajkd.2020.05.008
Chua HR, et al. Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic. Am J Kidney Dis. 2020;76(3):392-400. PubMed PMID: 32505811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic. AU - Chua,Horng-Ruey, AU - MacLaren,Graeme, AU - Choong,Lina Hui-Lin, AU - Chionh,Chang-Yin, AU - Khoo,Benjamin Zhi En, AU - Yeo,See-Cheng, AU - Sewa,Duu-Wen, AU - Ng,Shin-Yi, AU - Choo,Jason Chon-Jun, AU - Teo,Boon-Wee, AU - Tan,Han-Khim, AU - Siow,Wen-Ting, AU - Agrawal,Rohit Vijay, AU - Tan,Chieh-Suai, AU - Vathsala,Anantharaman, AU - Tagore,Rajat, AU - Seow,Terina Ying-Ying, AU - Khatri,Priyanka, AU - Hong,Wei-Zhen, AU - Kaushik,Manish, Y1 - 2020/06/04/ PY - 2020/04/25/received PY - 2020/05/27/accepted PY - 2020/6/9/pubmed PY - 2020/9/2/medline PY - 2020/6/8/entrez KW - Acute kidney injury (AKI) KW - citrates KW - continuous renal replacement therapy (CRRT) KW - coronavirus 19 disease (COVID-19) KW - dialysis solutions KW - kidney failure KW - nursing staff KW - pandemics KW - resource management KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) KW - workload SP - 392 EP - 400 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 76 IS - 3 N2 - With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/32505811/Ensuring_Sustainability_of_Continuous_Kidney_Replacement_Therapy_in_the_Face_of_Extraordinary_Demand:_Lessons_From_the_COVID_19_Pandemic_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(20)30730-7 DB - PRIME DP - Unbound Medicine ER -