Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Am J Emerg Med. 2021 Feb;40:47-54. doi: 10.1016/j.ajem.2020.12.006. Epub 2020 Dec 11.
The COVID-19 pandemic poses significant challenges to patients with end-stage kidney disease who receive treatment in outpatient dialysis centers. These patients represent a fragile population that is at higher risk for both infection and transmission. At the start of the pandemic, many suspected COVID-19 dialysis patients were diverted to the emergency department (ED) for testing/treatment, placing a tremendous burden on the ED and inpatient dialysis units. Several recommendations and guidelines have been established to optimize patient care while also decreasing the burden on the ED and inpatient dialysis units and maximizing the ability to perform outpatient hemodialysis. As the pandemic continues, dialysis facilities will have an increasing burden to provide safe and accessible dialysis, while also being able to direct patients to the ED for either emergent dialysis or COVID-19 treatment/testing. We reviewed opinions, recommendations and guidelines developed by professional organizations and dialysis facilities for the management of "patients under investigation" (PUIs) and COVID-19 positive patients that depend on whether the suspicion occurs while the patient is at home vs. at the dialysis center.
COVID-19 大流行给在门诊透析中心接受治疗的终末期肾病患者带来了重大挑战。这些患者代表了一个脆弱的群体，他们感染和传播的风险更高。在大流行开始时，许多疑似 COVID-19 透析患者被转至急诊部（ED）进行检测/治疗，这给 ED 和住院透析单位带来了巨大的负担。已经制定了一些建议和指南，以优化患者护理，同时减轻 ED 和住院透析单位的负担，并最大限度地提高进行门诊血液透析的能力。随着大流行的持续，透析机构将面临越来越大的负担，需要提供安全和便捷的透析服务，同时还能够将患者转至 ED 进行紧急透析或 COVID-19 治疗/检测。我们审查了专业组织和透析机构为管理“疑似患者”（PUIs）和 COVID-19 阳性患者制定的意见、建议和指南，这些意见、建议和指南取决于怀疑是在患者家中还是在透析中心发生的。
