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https://doi.org/10.1053/j.ajkd.2020.05.008
Title: | Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic | Authors: | Chua, Horng-Ruey MacLaren, Graeme Choong, Lina Hui-Lin Chionh, Chang-Yin Khoo, Benjamin Zhi En Yeo, See-Cheng Sewa, Duu-Wen Ng, Shin-Yi Choo, Jason Chon-Jun Teo, Boon-Wee Tan, Han-Khim Siow, Wen-Ting Agrawal, Rohit Vijay Tan, Chieh-Suai Vathsala, Anantharaman Tagore, Rajat Seow, Terina Ying-Ying Khatri, Priyanka Hong, Wei-Zhen Kaushik, Manish |
Keywords: | Science & Technology Life Sciences & Biomedicine Urology & Nephrology ACCELERATED VENOVENOUS HEMOFILTRATION REGIONAL CITRATE ANTICOAGULATION PERITONEAL-DIALYSIS ACID-BASE HEMODIALYSIS CATHETERS INJURY SAFETY RISK INTENSITY |
Issue Date: | 1-Sep-2020 | Publisher: | W B SAUNDERS CO-ELSEVIER INC | Citation: | Chua, Horng-Ruey, MacLaren, Graeme, Choong, Lina Hui-Lin, Chionh, Chang-Yin, Khoo, Benjamin Zhi En, Yeo, See-Cheng, Sewa, Duu-Wen, Ng, Shin-Yi, Choo, Jason Chon-Jun, Teo, Boon-Wee, Tan, Han-Khim, Siow, Wen-Ting, Agrawal, Rohit Vijay, Tan, Chieh-Suai, Vathsala, Anantharaman, Tagore, Rajat, Seow, Terina Ying-Ying, Khatri, Priyanka, Hong, Wei-Zhen, Kaushik, Manish (2020-09-01). Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic. AMERICAN JOURNAL OF KIDNEY DISEASES 76 (3) : 392-400. ScholarBank@NUS Repository. https://doi.org/10.1053/j.ajkd.2020.05.008 | 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. | Source Title: | AMERICAN JOURNAL OF KIDNEY DISEASES | URI: | https://scholarbank.nus.edu.sg/handle/10635/206108 | ISSN: | 02726386 15236838 |
DOI: | 10.1053/j.ajkd.2020.05.008 |
Appears in Collections: | Staff Publications Elements |
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