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Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic.
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.
  • Chua HR; 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.
  • MacLaren G; 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.
  • Choong LH; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
  • Chionh CY; Department of Renal Medicine, Changi General Hospital, Singapore.
  • Khoo BZE; Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.
  • Yeo SC; Department of Renal Medicine, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
  • Sewa DW; Duke-NUS Medical School, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
  • Ng SY; Duke-NUS Medical School, Singapore; Department of Surgical Intensive Care, Singapore General Hospital, Singapore.
  • Choo JC; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
  • Teo BW; Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Tan HK; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
  • Siow WT; 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.
  • Agrawal RV; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Anaesthesia, National University Hospital, Singapore.
  • Tan CS; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
  • Vathsala A; Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Tagore R; Division of Renal Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore.
  • Seow TY; Division of Renal Medicine, Department of Medicine, Sengkang General Hospital, Singapore.
  • Khatri P; Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore.
  • Hong WZ; Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore.
  • Kaushik M; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore. Electronic address: manish.kaushik@singhealth.com.sg.
Am J Kidney Dis ; 76(3): 392-400, 2020 09.
Article in English | MEDLINE | ID: covidwho-526769
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Betacoronavirus / Continuous Renal Replacement Therapy / Health Services Needs and Demand Type of study: Observational study Limits: Humans Language: English Journal: Am J Kidney Dis Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Betacoronavirus / Continuous Renal Replacement Therapy / Health Services Needs and Demand Type of study: Observational study Limits: Humans Language: English Journal: Am J Kidney Dis Year: 2020 Document Type: Article