During the current COVID-19 pandemic, there has been a surge in patients requiring intensive care throughout the United States. “Early in the pandemic, US healthcare systems worked to increase the number of hospital beds and the availability of ventilators to care for critically ill patients with COVID-19,” explains Yuvaram Reddy, MBBS. “Although serious illnesses like COVID-19 can affect the kidneys, less attention has been paid toward increasing the number of continuous kidney replacement therapy  (CKRT) machines that are needed to treat critically ill patients during the pandemic.”

Studies show that 5% to 7% of critically ill patients with COVID-19 will develop stage 3 acute kidney injury requiring dialysis. Anticipating this surge, healthcare systems activated crisis capacity measures for inpatient kidney replacement therapy, but the impact of these measures was largely unknown or purely anecdotal. “Without adequate data on the number of CKRT machines available and in use, it’s difficult to predict how many of these machines are needed and how much of a machine shortage, if any, might be encountered,” says Dr. Reddy.

Projected CKRT Machine Shortages

In a study published in the American Journal of Kidney Diseases, Dr. Reddy and colleagues developed mathematical models of CKRT demand and capacity in an effort to inform emergency planning, identify areas for which more data are needed, and mitigate CKRT shortages during the pandemic and in future healthcare crises. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature.

“At the peak of the early phase of the pandemic, defined as February to August 2020 for the study, our mathematical models projected a combined shortage of more than 1,000 CKRT machines, with shortages in six states—Connecticut, Maryland, Massachusetts, Michigan, New Jersey, and New York,” says Dr. Reddy (Figure). “Additionally, possible shortages were projected in eight states—Arizona, Colorado, Louisiana, Nebraska, New Mexico, Rhode Island, South Carolina, and Wyoming.” In the best- and worst-case scenarios, there were shortages of CKRT machines in three and 26 states, respectively.

A National Stockpile

While the models used in the study cannot be used for county- or hospital-level decision making, the researchers reported that they may be of value in providing high-level projections of CKRT shortages. “While we sought to estimate shortages in CKRT machines on a local healthcare system level, the US currently lacks the data required to perform such an analysis,” Dr. Reddy says. “Therefore, we estimated shortages at the state and national level. If policymakers worked with nephrologists to create a national data registry of the availability and use of dialysis machines across the country, it could improve future mathematical models so that we can develop better emergency preparedness plans.”

The study group recommends creating a national multidisciplinary task force comprising key stakeholders from the federal government, the nephrology community, industry, and patients to improve data collection and emergency preparedness planning for CKRT machines. Key task force initiatives include ensuring that a national registry provides real-world data on inpatient CKRT machines, supplies, and personnel, as well as identifying approaches to creating a national stockpile of dialysis machines.

“Sharing CKRT machines across healthcare systems and developing a more robust national stockpile of these machines may help limit shortages during healthcare crises,” says Dr. Reddy. Of note, as hospitals return to standard capacities when the pandemic eventually ends, there will likely be a surplus of CKRT machines. This creates a unique opportunity to repurpose these machines to provide relief for future waves of COVID-19 and other healthcare crises.

Dr. Reddy says that future research should be aimed at collecting and analyzing local hospital, healthcare system, and county-level data on the availability and use of dialysis machines. “Equipped with these data, the US can mitigate the risk and impact of CKRT shortages during current and future healthcare crises through improved emergency preparedness planning,” he says.

References

Reddy YN, Walensky RB, Mendu ML, Green G, Reddy KP. Estimating shortages in capacity to deliver continuous kidney replacement therapy during the COVID-19 pandemic in the United States. Am J Kidney Dis. 2020;76(5):696-709.e1. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385068/.

Ranney ML, Griffeth V, Jha AK. Critical supply shortages – the need for ventilators and personal protective equipment during the COVID-19 pandemic. N Engl J Med. 2020;382(18):e41.

Melo FAF, Macedo E, Fonseca Bezerra AC, et al. A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries. PLoS One. 2020;15(1):e0226325.

El Shamy O, Sharma S,Winston J, Uribarri J. Peritoneal dialysis during the coronavirus 2019 (COVID-19) pandemic: acute inpatient and maintenance outpatient experiences. Kidney Med. 2020;2(4):377-380.