Strategies for safely transporting dialysis patients with COVID-19, as well as for discontinuing isolation for staff and patients after infections, were highlighted during an ASN webinar on COVID-19 hosted by Nephrologists Transforming Dialysis Patient Safety.
Infection control strategies
The Centers for Disease Control and Prevention’s (CDC) COVID-19 website for dialysis providers now includes more detailed information about screening for COVID-19 and triage of patients upon arrival at dialysis centers, said Shannon Novosad, MD, MPH, medical officer with the Dialysis Safety Team in the Division of Healthcare Quality Promotion at the CDC. She noted that the recommendations haven’t changed, but that
Humans face an unprecedented situation today. Human coronavirus disease 19 (COVID-19) has caught everyone, regardless of borders and competence of existing healthcare infrastructures, completely unaware.
The way the disease has spread across the world over 4 months aptly reflects the meaning of “viral” as it is used in social media, where the term frequently describes something that garners immense worldwide publicity within a very short time. The sudden temporal clustering of numerous cases of unexplained rapidly progressive pneumonia leading to respiratory failure baffled clinicians in Wuhan, China, in December 2019. As could be expected, suspicion of some new affliction grew
Good communication, creative use of resources, and protecting dialysis and other hospital staff are all keys to success in caring for COVID-19-positive patients with end-stage kidney disease and acute kidney injury in the hospital, according to Michele H. Mokrzycki, MD, MS, professor of medicine at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx,.
The pandemic developed in New York very quickly, Mokrzycki said, from a few international travelers to hotspots to many communities. As of late spring, her hospital had admitted 829 patients with COVID-19. The nephrology service cared for 47 hemodialysis patients with COVID, 8.5%
Dialysis patients pose a major challenge for limiting the spread of the SARS-CoV-2 virus, as they normally receive thrice weekly dialysis in often densely populated outpatient centers. They may have compromised immune systems, and many have additional health comorbidities that put them at risk of poor outcomes from COVID-19 (1).
Early in the pandemic, many symptomatic dialysis patients positive for COVID-19 were transferred to hospitals to reduce the risk of spread at outpatient dialysis units (1). It became clear, however, that triaging all such patients to hospitals might unnecessarily strain inpatient dialysis units, which might already
Renal replacement therapy (RRT) should be initiated for acute kidney injury (AKI) patients who have life-threatening complications and are not responding to medical management, said Anitha Vijayan, MD, FASN, including those with volume overload and respiratory failure, hyperkalemia, or metabolic acidosis. But be wary of aggressive fluid resuscitation, said Vijayan, a professor of medicine at Washington University School of Medicine in St. Louis.
She noted there is no data yet to support early initiation of RRT in COVID patients.
Available RRT modalities that may be employed include continuous renal replacement therapy (CRRT), prolonged intermittent renal replacement therapy (PIRRT), or intermittent
As dialysis centers prepare for the the need—either current or increasingly likely—for inpatient units to work at surge capacity to manage patients during the COVID-19 pandemic, it’s becoming clear that constraints on both personnel and resource supplies may make it impossible to successfully dialyze all patients using standard procedures. In such a scenario, institutions may aim to temporarily adjust their standard of care to provide sufficient treatments to as many patients as possible.
A paper in the Clinical Journal of the American Society of Nephrology provides guidance about different strategies and contingency plans that might be employed. Jamie
Nurses and patient care technicians are on the front lines in the multiple short-term and long-term dialysis units that are caring for patients who may have COVID-19. Dialysis patients and staff have been hit hard by this virus, with more than 6000 patients and more than 700 staff members receiving positive test results as of April 21, 2020. More than 790 dialysis patients have died as a result of COVID-19.
Seattle was the initial locus of the virus, and the first death in the United States was that of a dialysis patient. New York City then became the “leader” in
Like every corner of the medical community, kidney patient advocacy groups have mobilized in response to the COVID-19 pandemic. The many responses include direct monetary grants to patients; education for patients about the virus and how they can react; increased efforts for communication, networking, and counseling; and mobilization for political activity.
With the flurry of activity, patients with internet access may be receiving more information and support than ever.
The American Kidney Fund (AKF) opened applications for its Coronavirus Emergency Fund (https://www.kidneyfund.org/news/akf-launches-coronavirus-emergency-fund-to-help-low-income-dialysis-and-transplant-patients.html) on March 23 to provide $250 grants to any US dialysis patients or recent kidney transplant
Kidney News Editorial Board member Edgar Lerma, MD, interviewed Joel Topf, MD, about his experience on the front lines of the COVID-19 pandemic. Topf is a private practice nephrologist who works primarily at St. John Ascension in Detroit. He is also on the faculty of the St. John Nephrology Fellowship program, where he teaches residents and medical students, using his academic energy to engage them through social media. He is co-creator of NephJC and NephMadness and hosts a nephrology-focused podcast called Freely Filtered.
How did you get to be on the COVID-19 front lines? Did you
In July 2019, President Trump signed an executive order to launch Advancing American Kidney Health. This event underscored the importance and the urgency of recognizing kidney disease as a national priority. One of the three goals of this order is to double the number of kidneys available for transplantation by 2030. Although this idea might appear to be impracticable at the outset, the data presented in this brief report suggest that the process is already well under way.
Since 2014, the majority of the kidney transplantation centers across the United States have reported record increases in the volume of kidney