Table 1 Challenges in managing patients with kidney disease during the COVID-19 pandemic
From: Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions
Cohort type | Challenges | Solutions | Actions required |
|---|---|---|---|
AKI | Increased demand for bedside dialysis and CRRT Shortage of dialysis solutions and workforce | Organization of multidisciplinary crisis team to include nephrologists, nurses and hospital administrators Taking inventory of all aspects of RRT Tracking daily need for RRT Modification of HD and CRRT protocols to meet increased demand Utility of acute PD Redeployment of faculty, trainees and nurses to meet needs | Develop a framework for addressing system capacity, challenges in communication and allocating resources founded on ethical principles Educate patients about AKI and risks |
CKD | Interruption of new consultations and follow-up care Laboratory monitoring of CKD Limited pre-dialysis access care due to the pandemic Lack of data on therapeutics and vaccine response in the CKD population | Adoption of telemedicine for all except urgent cases requiring in-person evaluation Restrict laboratory tests to those with rapid turnaround for clinical care and use non-hospital-based labs for blood draw Home urine dipstick monitoring Include vascular access surgeries and PD catheter placement among essential procedures | Evaluate disparities in digital literacy and establish a protocol to include telemedicine navigators to facilitate telemedicine Advocacy for inclusion of CKD cohorts in clinical trials of therapeutics and vaccines |
Patients with ESKD on maintenance dialysis | Safe continuation of thrice weekly in-centre dialysis Training for home dialysis modalities and longitudinal care for home dialysis patients Delay in dialysis access placement Delays in transplant evaluation and placement on waiting list Lack of data on therapeutics and vaccine response in the ESKD population | Protocol for symptom screening for infection and universal masking Cohorting infected patients in designated COVID units Wider adoption of home dialysis modalities Conversion from in-person to televisit for in-centre and home dialysis patients Inclusion of dialysis access as an essential procedure Reduction of dialysis sessions to twice a week Conversion to home dialysis | Universal viral testing for symptomatic in-centre dialysis patients Stock-piling of emergency medical equipment and dialysis supplies Adoption of assisted peritoneal dialysis and home hemodialysis Development of algorithms to accelerate evaluation and placement of medically stable individuals on waiting list Inclusion of patients with ESKD in clinical trials of therapeutics and vaccines |
Kidney transplant recipients | Strategies to reduce risk of infection Continuation of evaluation for transplant candidacy Continuation of transplant surgeries Evaluating vaccine efficacy | Adoption of telemedicine and remote monitoring Suspension of live donation and decrease in DDKT Vaccine prioritization, booster doses, vaccination of household contacts | Leveraging health care technology to aid remote monitoring of vital signs and glucose Algorithm for individualized approach to continuing transplant surgery Strategies to enhance vaccine efficacy |
Immune-mediated kidney disease | Strategies to reduce risk of infection Identifying immunosuppressive classes associated with increased risk of infection Evaluating vaccine efficacy | Adoption of telemedicine and remote monitoring Decrease in frequency of laboratory monitoring Delaying use of biologics in stable patients Vaccine prioritization, booster doses, vaccination of household contacts | Leveraging health care technology to aid remote monitoring of disease activity and adoption of urine dipstick monitoring Comparing utility of non-invasive disease biomarkers and kidney biopsy for glomerular diseases Algorithms to personalize maintenance immunosuppressive therapy for relapsing diseases Strategies to enhance vaccine efficacy |
Children living with kidney disease | Interruption of follow-up care for CKD Continuation of transplant surgeries Lack of data on therapeutics and vaccine response in the CKD population Psychological impact of isolation and shielding Caregiver burden | Adoption of telemedicine and remote monitoring Suspension of live donation | Wider adoption of home dialysis Strategies to address caregiver burden Inclusion of children in clinical trials and prioritization of high-risk groups for vaccines Research into kidney health and cardiovascular consequences of the pandemic Address paediatric health equity through research and public policy Ensure resources to maintain critical services for children on dialysis Utilize patient-reported outcomes along with relevant health measures |
