Experiences of Renal Replacement Therapy Delivery in Swedish Intensive Care Units during the COVID-19 Pandemic

Abstract

<b><i>Background:</i></b> The COVID-19 pandemic led to a rapidly increased demand for intensive care unit (ICU) and renal replacement therapy (RRT) worldwide. RRT delivery was threatened by a lack of specially trained staff and equipment. We investigated how the first wave of COVID-19 affected RRT delivery in Swedish ICUs. <b><i>Methods:</i></b> An Internet-based questionnaire was sent to ICU lead physicians which included quantitative and qualitative questions regarding RRT demand, equipment availability, and use of continuous renal replacement therapy (CRRT), intermittent haemodialysis (IHD), and peritoneal dialysis (PD) during spring 2020. <b><i>Results:</i></b> Twenty-five ICUs responded and these treated 64% of COVID-19 ICU patients in Sweden. ICU capacity increased by 292% (IQR 171–347%). Median peak capacity was reached during the 18th week of the year. RRT use increased overall by 133% and in Stockholm by 188%. 36% of units sequestered CRRT machines. IHD was used in 68% and PD in 12% of ICUs. RRT fluid and filter shortages were experienced by 45% and 33% of wards, respectively; consequently, prescription alterations were made by 24% of ICUs. Calcium solution shortages were reported in 12% of units that led to citrate protocol changes. Staffing shortages resulted in RRT sometimes being delivered by non-RRT-trained staff, safety incidents relating to this occurred, although no patient harm was reported. <b><i>Conclusion:</i></b> During the first wave of the COVID-19 pandemic, RRT demand increased extensively causing staff and equipment shortages, altered CRRT protocols, and increased use of IHD and PD. The impact on patient outcomes should be assessed to effectively plan for further surge capacity RRT demand.

The Impact of COVID-19 on Postdischarge Outcomes for Dialysis Patients in the United States: Evidence from Medicare Claims Data

“…Thus, it has been crucial to take measures to combat the spread of SARS-CoV-2 in dialysis facilities where physical distancing is difficult to practice (45). On the other hand, early reports in areas with high COVID-19 incidence indicated that a nontrivial number of patients without ESKD had AKI and required inpatient dialysis at hospital due to COVID-19 (46, 47). It is possible that this depletion of hospital resources in some cases might have led to early discharges for some patients with ESKD who were on dialysis before they were sufficiently clinically stable, and the strain on health care providers might have impeded typical postdischarge care coordination processes between the hospital and dialysis facility.…”

Is It Time to Give Peritoneal Dialysis Its Due Place in Managing Acute Kidney Injury: Lessons Learnt from COVID-19 Pandemic

“…During the height of COVID-19 pandemic, the developed world was confronted with a sudden surge in the number of patients with severe AKI putting tremendous strain on the healthcare system [16]. Many countries faced acute shortages of ICU beds, CRRT machines, and trained ICU staff, exposing the shortcomings of the prevailing healthcare infrastructures and exclusive reliance on CRRT for managing AKI [12].…”

Multistate Modeling of Clinical Trajectories and Outcomes in the ICU: A Proof-of-Concept Evaluation of Acute Kidney Injury Among Critically Ill Patients With COVID-19

“…AKI is a well-described complication of COVID-19 critical illness, including high rates of renal replacement therapy (RRT) and (especially during the initial surge) lower-than-expected rates of renal recovery (8)(9)(10)(11)(12)(13). Given the frequency of resource constraints-and risks of rationed care-in earlier pandemic waves, a detailed understanding of critically ill patients at risk for AKI and RRT might have informed planning and allocation of finite resources such as RRT devices and supplies, appropriately trained staff, and electrolyte replacement fluids (14)(15)(16)(17), which necessitated alterations in dialysis dosing, schedule, modality, and staffing in prior waves (18,19). In this applied example, we provide insight into the practicalities and pitfalls of using multistate modeling in critical care outcomes research.…”