Please use this identifier to cite or link to this item: 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
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