Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer’s Perspective

Anger, Michael; Mullon, Claudy; Ficociello, Linda H.; Thompson, David B.; Kraus, Michael A.; Newcomb, Pete; Kossmann, Robert J.

doi:10.34067/kid.0006192020

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Interestingly, the ICU CFR did not change from 2020 to 2021. This discrepancy is challenging to reconcile and raises the possibility that changes in care strategies, such as more frequent and prolonged utilization of noninvasive respiratory support, application of noninvasive ventilation outside of ICU settings, and reluctance or shortages of resources to provide RRT may have resulted in the observed changes in organ-specific CFRs ( 167 , 168 ).…”

Section: Discussionmentioning

confidence: 99%

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel

Leazer

Alcover

et al. 2023

Critical Care Explorations

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OBJECTIVES:To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.DATA SOURCES: A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.STUDY SELECTION: Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.DATA EXTRACTION: Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.

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Section: Discussionmentioning

confidence: 99%

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel

Leazer

Alcover

et al. 2023

Critical Care Explorations

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“…The mortality rate for patients with AKI requiring dialysis (AKI-RRT) in the ICU is greater than 50% [3][4][5][6], which can be explained by the increase in age and the burden of comorbidities in critically ill patients in recent years. The COVID-19 pandemic caused by the new coronavirus SARS-CoV-2 significantly affected nephrological practice, increasing the demand for nephrologists, nephrologyspecialized nurses, RRT equipment and supplies [7]. Knowing the incidence, characteristics, and outcomes of AKI associated with COVID-19 is essential for health planning.…”

Section: Introductionmentioning

confidence: 99%

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

et al. 2022

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Introduction Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. Methods This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. Results The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. Conclusion AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).

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“…This crisis led to the development of resource management policies in acute dialysis units across hospitals ( 53 ). The shortage of CKRT machines led to the creation of regional and institutional policies on increasing supply and developing stockpiles of CKRT machines ( 54 , 55 ). Some academic centers adopted crisis protocols of prolonged intermittent kidney replacement therapy ( 56 ) or accelerated venovenous hemofiltration ( 57 ), and CKRT devices could be shared between patients.…”

Section: Impact Of the Covid-19 Pandemic On Dialysis Allocationmentioning

confidence: 99%

Dialysis resource allocation in critical care: the impact of the COVID-19 pandemic and the promise of big data analytics

Koraishy,

Mallipattu

2023

Front. Nephrol.

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The COVID-19 pandemic resulted in an unprecedented burden on intensive care units (ICUs). With increased demands and limited supply, critical care resources, including dialysis machines, became scarce, leading to the undertaking of value-based cost-effectiveness analyses and the rationing of resources to deliver patient care of the highest quality. A high proportion of COVID-19 patients admitted to the ICU required dialysis, resulting in a major burden on resources such as dialysis machines, nursing staff, technicians, and consumables such as dialysis filters and solutions and anticoagulation medications. Artificial intelligence (AI)-based big data analytics are now being utilized in multiple data-driven healthcare services, including the optimization of healthcare system utilization. Numerous factors can impact dialysis resource allocation to critically ill patients, especially during public health emergencies, but currently, resource allocation is determined using a small number of traditional factors. Smart analytics that take into account all the relevant healthcare information in the hospital system and patient outcomes can lead to improved resource allocation, cost-effectiveness, and quality of care. In this review, we discuss dialysis resource utilization in critical care, the impact of the COVID-19 pandemic, and how AI can improve resource utilization in future public health emergencies. Research in this area should be an important priority.

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Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer’s Perspective

Abstract: This is an Early Access article. Please select the PDF button, above, to view it.

Cited by 7 publications

References 22 publications

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

Dialysis resource allocation in critical care: the impact of the COVID-19 pandemic and the promise of big data analytics

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