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 P. Dwyer, MD, is a professor of medicine and director of the Nephrology Clinical Trials Center at Vanderbilt University Medical Center in Nashville, TN, and one of the authors of the study (1). Dwyer and colleagues published the paper to provide practical ideas about how inpatient dialysis units might best maximize their available staff and resources.
Although the incidence and pathophysiology are unclear, acute kidney injury occurs in a significant minority of COVID-19 patients, and many critically ill patients have required renal replacement therapies. In some areas of the country, kidney failure patients with suspected or confirmed COVID-19 infections on maintenance dialysis are being triaged to hospital centers, potentially further increasing the strain on inpatient dialysis units.
Burgner A, Ikizler T, Dwyer J. COVID-19 and the inpatient dialysis unit: managing resources during contingency planning pre-crisis Clin J Am Soc Nephrol 2020. DOI: https://doi.org/10.2215/CJN.03750320