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

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    Author
    Chua, H-R; MacLaren, G; Choong, LH-L; Chionh, C-Y; Khoo, BZE; Yeo, S-C; Sewa, D-W; Ng, S-Y; Choo, JC-J; Teo, B-W; ...
    Date
    2020-09-01
    Source Title
    American Journal of Kidney Diseases
    Publisher
    W B SAUNDERS CO-ELSEVIER INC
    University of Melbourne Author/s
    MacLaren, Graeme
    Affiliation
    Paediatrics (RCH)
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Chua, H. -R., MacLaren, G., Choong, L. H. -L., Chionh, C. -Y., Khoo, B. Z. E., Yeo, S. -C., Sewa, D. -W., Ng, S. -Y., Choo, J. C. -J., Teo, B. -W., Tan, H. -K., Siow, W. -T., Agrawal, R. V., Tan, C. -S., Vathsala, A., Tagore, R., Seow, T. Y. -Y., Khatri, P., Hong, W. -Z. & Kaushik, M. (2020). 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), pp.392-400. https://doi.org/10.1053/j.ajkd.2020.05.008.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/254509
    DOI
    10.1053/j.ajkd.2020.05.008
    Open Access URL
    https://europepmc.org/articles/PMC7272152?pdf=render
    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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