Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States

Am J Kidney Dis. 2020 Nov;76(5):696-709.e1. doi: 10.1053/j.ajkd.2020.07.005. Epub 2020 Jul 28.

Abstract

Rationale & objective: During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis. To inform planning for current and future crises, we estimated CKRT demand and capacity during the initial wave of the US COVID-19 pandemic.

Study design: We developed mathematical models to project nationwide and statewide CKRT demand and capacity. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature.

Setting & population: US patients hospitalized during the initial wave of the COVID-19 pandemic (February 6, 2020, to August 4, 2020).

Intervention: CKRT.

Outcomes: CKRT demand and capacity at peak resource use; number of states projected to encounter CKRT shortages.

Model, perspective, & timeframe: Health sector perspective with a 6-month time horizon.

Results: Under base-case model assumptions, there was a nationwide CKRT capacity of 7,032 machines, an estimated shortage of 1,088 (95% uncertainty interval, 910-1,568) machines, and shortages in 6 states at peak resource use. In sensitivity analyses, varying assumptions around: (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of acute kidney injury stage 3 requiring dialysis requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3 to 8 states (933-1,282 machines) and 4 to 8 states (945-1,723 machines), respectively. In the best- and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines).

Limitations: Parameter estimates are influenced by assumptions made in the absence of published data for CKRT capacity and by the Institute for Health Metrics and Evaluation model's limitations.

Conclusions: Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings, although based on limited data for CKRT demand and capacity, suggest there being value during health care crises such as the COVID-19 pandemic in establishing an inpatient kidney replacement therapy national registry and maintaining a national stockpile of CKRT equipment.

Keywords: Continuous renal replacement therapy (CRRT); acute care; acute kidney injury (AKI); acute kidney injury stage 3 requiring dialysis (AKI 3D); acute renal failure (ARF); continuous kidney replacement therapy (CKRT); coronavirus disease 2019 (COVID-19); mathematical model; pandemic; resource allocation; resource shortage; shortages.

MeSH terms

  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / therapy
  • Betacoronavirus
  • COVID-19
  • Civil Defense* / methods
  • Civil Defense* / organization & administration
  • Continuous Renal Replacement Therapy / methods*
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / therapy
  • Critical Illness* / epidemiology
  • Critical Illness* / therapy
  • Health Services Needs and Demand / organization & administration*
  • Humans
  • Intensive Care Units / supply & distribution*
  • Models, Theoretical
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / therapy
  • Procedures and Techniques Utilization / statistics & numerical data
  • Risk Assessment / methods
  • SARS-CoV-2
  • Strategic Stockpile / methods*
  • United States / epidemiology