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Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States.
Reddy, Yuvaram N V; Walensky, Rochelle P; Mendu, Mallika L; Green, Nathaniel; Reddy, Krishna P.
  • Reddy YNV; 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.
  • Walensky RP; Harvard Medical School, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.
  • Mendu ML; Renal Division, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Green N; American Biomedical Group, Inc, Oklahoma City, OK.
  • Reddy KP; 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.
Am J Kidney Dis ; 76(5): 696-709.e1, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-676627
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.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Neumonía Viral / Defensa Civil / Enfermedad Crítica / Infecciones por Coronavirus / Lesión Renal Aguda / Pandemias / Reserva Estratégica / Terapia de Reemplazo Renal Continuo / Necesidades y Demandas de Servicios de Salud / Unidades de Cuidados Intensivos Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Humanos País/Región como asunto: America del Norte Idioma: Inglés Revista: Am J Kidney Dis Año: 2020 Tipo del documento: Artículo

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Neumonía Viral / Defensa Civil / Enfermedad Crítica / Infecciones por Coronavirus / Lesión Renal Aguda / Pandemias / Reserva Estratégica / Terapia de Reemplazo Renal Continuo / Necesidades y Demandas de Servicios de Salud / Unidades de Cuidados Intensivos Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Humanos País/Región como asunto: America del Norte Idioma: Inglés Revista: Am J Kidney Dis Año: 2020 Tipo del documento: Artículo