• Am. J. Kidney Dis. · Sep 2020

    Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic.

    • Horng-Ruey Chua, Graeme MacLaren, Lina Hui-Lin Choong, Chang-Yin Chionh, Benjamin Zhi En Khoo, See-Cheng Yeo, Duu-Wen Sewa, Shin-Yi Ng, Jason Chon-Jun Choo, Boon-Wee Teo, Han-Khim Tan, Wen-Ting Siow, Rohit Vijay Agrawal, Chieh-Suai Tan, Anantharaman Vathsala, Rajat Tagore, Terina Ying-Ying Seow, Priyanka Khatri, Wei-Zhen Hong, and Manish Kaushik.
    • 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.
    • Am. J. Kidney Dis. 2020 Sep 1; 76 (3): 392-400.

    AbstractWith 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.Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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