Because of the unprecedented increase in critically ill patients with coronavirus disease 2019 (COVID-19), capacity to provide continuous RRT (CRRT) for AKI may quickly be overwhelmed (1). Exacerbating this resource crunch is the hypercoagulability observed in COVID-19 (2,3). Frequent CRRT circuit clotting leads to blood loss and wastage of already overextended resources, and need for troubleshooting increases health care provider exposure to infected patients. At our quaternary care academic institution, we perform CRRT using a uniform protocol in five intensive care units (ICUs). We do not use anticoagulation routinely but add it (mostly heparin) as needed. Additionally, for more than a decade, we have used regional citrate anticoagulation (RCA) as the default protocol in our surgical ICU. During the COVID-19 pandemic, our hospital added ten more ICUs. Systemic anticoagulation was available in all 16 ICUs, whereas RCA remained restricted to the surgical ICU, albeit with less frequent postfilter ionized calcium monitoring to reduce nurse exposure to infected patients. Herein, we describe our experience with the life of 502 CRRT circuits on different anticoagulation regimens in 80 patients with RT-PCR-confirmed COVID-19 who received continuous venovenous hemodialysis (NxStage System One) between March 5 and May 8, 2020 (Figure 1A). These circuits were categorized by their anticoagulation regimen at the time of filter stoppage: heparin (systemic unfractionated or low-mol wt heparin [LMWH]), prefilter heparin, argatroban, RCA (citrate), citrate plus heparin (when patients received systemic heparin for medical indications), or no anticoagulation (none). Circuit clotting was our analysis end point. Circuit life was the time (hours) from initiation of CRRT to clotting or censoring. Circuits that functioned beyond 72 hours were censored at 72 hours. Circuits terminated for reasons other than clotting were censored at the time of termination. We determined the association between circuit clotting and anticoagulation groups by Cox regression in Stata 16 software.

The association between the risk of mortality and cardiovascular implantable electronic device (CIED) infections has been well-established in the literature. As CIED implantations have increased in frequency in the past few decades, the incidence of CIED-related infections has also risen. Given the morbidity, mortality, and health-care costs associated with CIED infections, the prevention of device-related infection is a critical goal. Risk factors for developing CIED infections can be categorized as patient-, procedure-, or device-related. Numerous studies have highlighted different strategies for preventing CIED-related infections, which include patient optimization, device selection, and periprocedural preparation and treatment. Nonetheless, as the comorbidity burden of patients undergoing CIED implantation continues to increase, significant challenges in the successful elimination of CIED-related infections remain. This review provides a comprehensive overview of available evidence-based approaches and strategies to reduce the risk of CIED infections.

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Background The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown. Methods Our study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract-level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020, and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors. Results Of the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract-level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses. Conclusions Among patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19-related exposures, requiring targeted risk-mitigation strategies.