<p>Inpatient Dialysis Planning During the COVID-19 Pandemic: A Single-Center Experience and Review of the Literature</p>

Abstract

Background: COVID-19 has created havoc in healthcare systems worldwide, including shortages in equipment and supplies for dialysis in the acute setting. Methods: We compared our planning and experience at a tertiary care academic medical center to recommendations in the literature. Results: Published literature and our experience underscored the need to plan for adequate dialysis equipment, particularly for continuous renal replacement therapy in the ICU setting, adequate nursing, and flexible scheduling of chronic patients to accommodate the surge in acute patients. We discovered other "shortages" not mentioned in the literature: shortages in the number of portable reverse osmosis (RO) machines needed to prepare dialysis water, inadequate number of rooms in units designated for COVID-19 patients with plumbing for dialysis, and lack of temperature blending valves on sinks that necessitated using cold water only, and damaging the RO membranes. We identified the need for cooperation between nephrology and critical care medicine, hospital-based and community nephrologists and community dialysis units as well as nephrologists at other hospitals in the region. We turned to guidance from the hospital ethics committee. Conclusion: Planning for an expected surge in hospitalized patients requiring RRT demands coordination between critical care, dialysis and nursing services as well as community and hospital providers to make certain there are adequate dialysis resources. Our experience suggests that continuous dialysis is in greatest demand early in the illness, and that plans to increase supplies should be put in place. But, planning should also focus on unforeseen hospital-specific infrastructure shortages that can develop over time and hamper intermittent dialysis delivery to all patients who require treatment.

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

“…High-efficiency dialyzers were used since many patients were considered in high catabolic states [ 98 ]. Heparin-free dialysis was avoided to reduce the need for frequent circuit flushing [ 92 ] and the risk of clotting [ 42 ].…”

The Global Impact of the COVID-19 Pandemic on In-Center Hemodialysis Services: An ISN-Dialysis Outcomes Practice Patterns Study Survey

“…(16-20) Globally, HD centres have had to rapidly adopt new infection prevention and control (IPAC) and coronavirus testing policies and adapt established dialysis practices to safeguard patients and staff whilst still supporting continuation of dialysis services, depending on local resources. (21) The International Society of Nephrology (ISN) has advocated for equitable access to kidney care, and has highlighted challenges that some regions are facing. (16) We leveraged the ISN's network of national nephrology societies and registries to understand the impact of the pandemic on HD centres across the world.…”

The Nephrology Nursing Shortage: Insights From a Pandemic

“…Nephrologists also produced dialysate in-house to overcome commercial shortages, used urgent-start peritoneal dialysis due to lack of hemodialysis machines, and modified CRRT prescriptions to extend filter life. [12][13][14][15][16] Despite these adaptations, it was clear that the most vulnerable resource for delivering lifesaving care for kidney patients was the expertise of a nephrology nurse.…”