Division of Nephrology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, Singapore.
Am J Kidney Dis. 2020 Sep;76(3):392-400. doi: 10.1053/j.ajkd.2020.05.008. Epub 2020 Jun 4.
With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.
随着全球 2019 冠状病毒病（COVID-19）患者数量的指数级增长，为急性肾损伤或肾衰竭患者提供连续肾脏替代治疗（CKRT）所需的资源可能受到威胁。本文总结了可以立即实施的现有策略。应根据不断变化的 COVID-19 流行病学和常规工作量，每周预先进行多中心 CKRT 需求预测。应量化并获取相应的消耗品，并从多个供应商处实现来源多样化。应相应加快供应采购速度，以便积累数周的库存，并进行行政监督，以防止机构之间不成比例的囤积。通过优化回路抗凝以保留过滤器、延长每个血管通路的使用时间、降低血流量以减少柠檬酸盐消耗、适度调整 CKRT 强度以节省液体、或运行更高清除率的加速 KRT 以每台机器治疗更多患者，可以提高 CKRT 资源的使用效率。如果在物流上可行，早期过渡到在线生成透析液的间歇性血液透析，或在选定患者中紧急进行腹膜透析，可能有助于减少对 CKRT 的依赖。这些措施加上多中心合作和相应增加经过培训的医疗和护理人员配备水平，可能避免在大流行高峰期进行下游护理配给并拯救生命。
