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Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States.
Am J Kidney Dis. 2020 11; 76(5):696-709.e1.AJ

Abstract

RATIONALE & OBJECTIVE

During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis. To inform planning for current and future crises, we estimated CKRT demand and capacity during the initial wave of the US COVID-19 pandemic.

STUDY DESIGN

We developed mathematical models to project nationwide and statewide CKRT demand and capacity. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature.

SETTING & POPULATION

US patients hospitalized during the initial wave of the COVID-19 pandemic (February 6, 2020, to August 4, 2020).

INTERVENTION

CKRT.

OUTCOMES

CKRT demand and capacity at peak resource use; number of states projected to encounter CKRT shortages.

MODEL, PERSPECTIVE, & TIMEFRAME

Health sector perspective with a 6-month time horizon.

RESULTS

Under base-case model assumptions, there was a nationwide CKRT capacity of 7,032 machines, an estimated shortage of 1,088 (95% uncertainty interval, 910-1,568) machines, and shortages in 6 states at peak resource use. In sensitivity analyses, varying assumptions around: (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of acute kidney injury stage 3 requiring dialysis requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3 to 8 states (933-1,282 machines) and 4 to 8 states (945-1,723 machines), respectively. In the best- and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines).

LIMITATIONS

Parameter estimates are influenced by assumptions made in the absence of published data for CKRT capacity and by the Institute for Health Metrics and Evaluation model's limitations.

CONCLUSIONS

Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings, although based on limited data for CKRT demand and capacity, suggest there being value during health care crises such as the COVID-19 pandemic in establishing an inpatient kidney replacement therapy national registry and maintaining a national stockpile of CKRT equipment.

Authors+Show Affiliations

Renal Division, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of Nephrology, Massachusetts General Hospital, Boston, MA. Electronic address: yreddy@partners.org.Harvard Medical School, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.Renal Division, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.American Biomedical Group, Inc, Oklahoma City, OK.Harvard Medical School, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32730812

Citation

Reddy, Yuvaram N V., et al. "Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 76, no. 5, 2020, pp. 696-709.e1.
Reddy YNV, Walensky RP, Mendu ML, et al. Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States. Am J Kidney Dis. 2020;76(5):696-709.e1.
Reddy, Y. N. V., Walensky, R. P., Mendu, M. L., Green, N., & Reddy, K. P. (2020). Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 76(5), 696-e1. https://doi.org/10.1053/j.ajkd.2020.07.005
Reddy YNV, et al. Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States. Am J Kidney Dis. 2020;76(5):696-709.e1. PubMed PMID: 32730812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States. AU - Reddy,Yuvaram N V, AU - Walensky,Rochelle P, AU - Mendu,Mallika L, AU - Green,Nathaniel, AU - Reddy,Krishna P, Y1 - 2020/07/28/ PY - 2020/05/21/received PY - 2020/07/22/accepted PY - 2020/7/31/pubmed PY - 2020/11/3/medline PY - 2020/7/31/entrez KW - Continuous renal replacement therapy (CRRT) KW - acute care KW - acute kidney injury (AKI) KW - acute kidney injury stage 3 requiring dialysis (AKI 3D) KW - acute renal failure (ARF) KW - continuous kidney replacement therapy (CKRT) KW - coronavirus disease 2019 (COVID-19) KW - mathematical model KW - pandemic KW - resource allocation KW - resource shortage KW - shortages SP - 696 EP - 709.e1 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 76 IS - 5 N2 - RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis. To inform planning for current and future crises, we estimated CKRT demand and capacity during the initial wave of the US COVID-19 pandemic. STUDY DESIGN: We developed mathematical models to project nationwide and statewide CKRT demand and capacity. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature. SETTING & POPULATION: US patients hospitalized during the initial wave of the COVID-19 pandemic (February 6, 2020, to August 4, 2020). INTERVENTION: CKRT. OUTCOMES: CKRT demand and capacity at peak resource use; number of states projected to encounter CKRT shortages. MODEL, PERSPECTIVE, & TIMEFRAME: Health sector perspective with a 6-month time horizon. RESULTS: Under base-case model assumptions, there was a nationwide CKRT capacity of 7,032 machines, an estimated shortage of 1,088 (95% uncertainty interval, 910-1,568) machines, and shortages in 6 states at peak resource use. In sensitivity analyses, varying assumptions around: (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of acute kidney injury stage 3 requiring dialysis requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3 to 8 states (933-1,282 machines) and 4 to 8 states (945-1,723 machines), respectively. In the best- and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines). LIMITATIONS: Parameter estimates are influenced by assumptions made in the absence of published data for CKRT capacity and by the Institute for Health Metrics and Evaluation model's limitations. CONCLUSIONS: Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings, although based on limited data for CKRT demand and capacity, suggest there being value during health care crises such as the COVID-19 pandemic in establishing an inpatient kidney replacement therapy national registry and maintaining a national stockpile of CKRT equipment. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/32730812/Estimating_Shortages_in_Capacity_to_Deliver_Continuous_Kidney_Replacement_Therapy_During_the_COVID_19_Pandemic_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(20)30853-2 DB - PRIME DP - Unbound Medicine ER -