COVID-19: In Context

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective from the Spanish Nephrology

Sánchez-Alvarez, Emilio — Fri, 11 Sep 2020 09:31:44 GMT-07:00

COVID-19–Associated Acute Kidney Injury

Siew, Edward D. — Tue, 22 Sep 2020 12:25:26 GMT-07:00

Authors’ Reply

Batlle, Daniel — Wed, 01 Jul 2020 08:29:06 GMT-07:00

Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic

Gleeson, Shana E. — Tue, 28 Apr 2020 06:21:15 GMT-07:00

Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

Srivatana, Vesh — Fri, 24 Apr 2020 02:30:46 GMT-07:00

COVID-19 and Calcineurin Inhibitors: Should They Get Left Out in the Storm?

Willicombe, Michelle — Mon, 20 Apr 2020 12:06:55 GMT-07:00

Prioritizing Peritoneal Catheter Placement during the COVID-19 Pandemic

Oliver, Matthew J. — Fri, 12 Mar 2021 06:08:00 GMT-08:00

Postmortem Kidney Pathology Findings in Patients with COVID-19

Santoriello, Dominick — Wed, 29 Jul 2020 09:04:12 GMT-07:00

Acute Abdominal Pain in a COVID-19 Patient

Mocerino, Ryan — Thu, 25 Jun 2020 05:30:20 GMT-07:00

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective of Two Nephrologists in the United States

Mokrzycki, Michele H. — Wed, 25 Mar 2020 12:38:59 GMT-07:00

Human Kidney Spheroids and Monolayers Provide Insights into SARS-CoV-2 Renal Interactions

benjamin.dekel@gmail.com — Thu, 10 Jun 2021 10:55:33 GMT-07:00

Background Although coronavirus disease 2019 (COVID-19) causes significant morbidity, mainly from pulmonary involvement, extrapulmonary symptoms are also major components of the disease. Kidney disease, usually presenting as acute kidney injury (AKI), is particularly severe among patients with COVID-19. It is unknown, however, whether such injury results from direct kidney infection with COVID-19's causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or from indirect mechanisms. Methods Using ex vivo cell models, we sought to analyze SARS-Cov2 interactions with kidney tubular cells and assess direct tubular injury. These models comprised primary human kidney epithelial cells (derived from nephrectomies and grown as proliferating monolayers) and more quiescent three-dimensional kidney spheroids. Results We demonstrated that viral entry molecules and high baseline levels of type 1 interferon-related molecules were present in monolayers and kidney spheroids. Although both models support viral infection and replication, they did not exhibit a cytopathic effect and cell death, outcomes that were strongly present in SARS-CoV-2-infected controls (Vero E6 cultures). A comparison of monolayer and spheroid cultures demonstrated higher infectivity and replication of SARS-Cov-2 in actively proliferating monolayers, although the spheroid cultures exhibited higher levels of ACE2. Monolayers exhibited elevation of some tubular injury molecules—including molecules related to fibrosis (COL1A1 and STAT6) and dedifferentiation (SNAI2)—as well as a loss of cell identity, evident by reduction in megalin (LRP2). The three-dimensional spheroids were less prone to such injury. Conclusions SARS-CoV-2 can infect kidney cells without a cytopathic effect. AKI-induced cellular proliferation may potentially intensify infectivity and tubular damage by SARS-CoV-2, suggesting that early intervention in AKI is warranted to help minimize kidney infection.

Correction

American Society of Nephrology — Wed, 30 Sep 2020 10:00:27 GMT-07:00

Rationing Scarce Resources: The Potential Impact of COVID-19 on Patients with Chronic Kidney Disease

Silberzweig, Jeffrey — Wed, 15 Jul 2020 12:55:08 GMT-07:00

Possible Protective Effect of Renin-Angiotensin System Inhibitors in COVID-19 Induced Acute Kidney Injury

Kow, Chia Siang — Wed, 01 Jul 2020 08:29:06 GMT-07:00

Response to COVID-19 Infection in Hemodialysis Patients: An Australian Perspective

Polkinghorne, Kevan R. — Fri, 19 Jun 2020 09:12:27 GMT-07:00

Twice-Weekly Hemodialysis Is an Option for Many Patients in Times of Dialysis Unit Stress

Meyer, Timothy W. — Thu, 16 Apr 2020 06:17:58 GMT-07:00

Antibody Response to COVID-19 Vaccination in Patients Receiving Dialysis

sanand2@stanford.edu — Fri, 11 Jun 2021 06:31:07 GMT-07:00

High Incidence of Circuit Clotting in Critically Ill COVID-19 Patients Treated with Renal Replacement Therapy

Grenon, Eloïse — Fri, 28 May 2021 10:31:36 GMT-07:00

COVID-19 in Patients with Kidney Disease

Ajaimy, Maria — Tue, 07 Jul 2020 07:17:46 GMT-07:00

Protocol for local on-site dialysate production for continuous renal replacement therapy during the COVID-19 pandemic

sm2206@cumc.columbia.edu — Fri, 14 May 2021 11:46:11 GMT-07:00

Acute kidney injury frequently occurs in patients with COVID-19 and injury severe enough to require renal replacement therapy (RRT) is a common complication among critically-ill patients.[1-3] During the surge, there was a high demand for dialysate for continuous RRT, and this increase in demand coupled with vulnerabilities in the supply chain necessitated alternative approaches, including internal production of dialysate. Using a standard hemodialysis machine and off the shelf supplies as per Federal Drug Administration (FDA) guidelines, we developed a method for on-site dialysate production that is adaptable and can be used to fill multiple bags at once. The use of a central reverse osmosis unit, dedicated hemodialysis machine, sterile bags with separate ports for fill and use, and frequent testing will ensure stability, sterility and therefore safety of produced dialysate. Dialysate made in house was tested and showed both stability and sterility for at least 30 hours. This detailed description of our process for generating dialysate can serve as a guide for other programs experiencing similar vulnerabilities in the demand vs. supply of dialysate.

Does SARS-CoV-2 Infect the Kidney?

Khan, Shaza — Tue, 13 Oct 2020 06:52:13 GMT-07:00

Risks and Benefits of Kidney Transplantation during the COVID Pandemic: Transplant or Not Transplant?

eakalin@montefiore.org — Thu, 13 May 2021 05:57:09 GMT-07:00

COVID-19 disease has significantly affected the transplant community by leading to decreased transplant activity and increased waiting list time. As expected, COVID-19 causes substantial mortality in both end-stage renal disease and kidney transplant populations. This is due to underlying chronic kidney disease and a high prevalence of comorbid conditions such as diabetes mellitus, hypertension, and cardiovascular disease in this group. Transplant programs have faced the difficult decision of weighing the risks and benefits of transplantation during the pandemic. On one hand there is a risk of COVID-19 exposure leading to infection while patients are on maximum immunosuppression. Alternatively, there are risks of delaying transplantation, which will increase waitlist-time and may lead to waitlist-associated morbidity and mortality. Cautious and thoughtful selection of both the recipient's and donor's post-transplant management is required during the pandemic to mitigate the risk of morbidity and mortality associated with COVID-19. In this review article we aimed to discuss previous publications related to clinical outcomes of COVID-19 disease in kidney transplant recipients, end-stage renal disease patients on dialysis or on the transplant waiting-list and precautions transplant centers should take in decision making for recipient and donor selection and immunosuppressive management during the pandemic. Nevertheless, transplantation in this milieu does seem to be the correct decision with a careful patient and donor selection with safeguard protocols for infection prevention. Each center should do risk assessment based on their patient's age and medical comorbidities, waitlist time, degree of sensitization, cold ischemia time, status of vaccination, and severity of pandemic in their region.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education

Coffman, Thomas M. — Tue, 18 Aug 2020 05:47:30 GMT-07:00

Living behind the Mask amid Two Pandemics: COVID-19 and Social Injustice

Gee, Patrick O. — Tue, 08 Dec 2020 01:29:19 GMT-08:00

Increasing Peritoneal Dialysis Use in Response to the COVID-19 Pandemic: Will It Go Viral?

Brown, Edwina A. — Mon, 03 Aug 2020 08:33:52 GMT-07:00

Epidemiology and Outcomes of COVID-19 in Home Dialysis Patients Compared with In-Center Dialysis Patients

Hsu, Caroline M. — Wed, 09 Jun 2021 01:22:33 GMT-07:00

Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19

Sparks, Matthew A. — Fri, 27 Mar 2020 02:03:21 GMT-07:00

Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy

Gallieni, Maurizio — Fri, 17 Apr 2020 10:39:57 GMT-07:00

Genetic Roadmap for Kidney Involvement of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

Zhang, Yue-miao — Thu, 23 Apr 2020 06:00:39 GMT-07:00

Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19

Adamsick, Meagan L. — Mon, 08 Jun 2020 05:30:27 GMT-07:00

COVID-19 Perspective from a Hemodialysis Patient

Allon, Michael — Thu, 07 May 2020 01:26:35 GMT-07:00

Acute Kidney Injury in the Time of COVID-19

Chan, Lili — Thu, 11 Jun 2020 09:42:44 GMT-07:00

Early Humoral Responses of Hemodialysis Patients after COVID-19 Vaccination with BNT162b2

Claudius.Speer@med.uni-heidelberg.de — Mon, 24 May 2021 02:37:49 GMT-07:00

Background and objectives Patients receiving hemodialysis are at high risk for both SARS-CoV-2 infection and severe COVID-19 disease. A life-saving vaccine is available, but sensitivity to vaccines is generally lower in dialysis patients. Little is yet known about antibody responses after COVID-19 vaccination in this vulnerable group. Design, setting, participants, and measurements In this prospective single-center study, we included 22 dialysis patients and 46 healthy controls from Heidelberg University Hospital between December 2020 and February 2021. We measured anti-S1 IgG with a threshold index for detection >1, neutralizing antibodies with a threshold for viral neutralization of ≥30% and antibodies against different SARS-CoV-2 fragments 17-22 days after the first and 18-22 days after the second dose of the mRNA vaccine BNT162b2. Results After the first vaccine dose, 4/22 (18%) dialysis patients compared with 43/46 (93%) healthy controls developed positive anti-S1 IgG, with a median (IQR) anti-S1 IgG index of 0.2 (0.1-0.7) compared with 9 (4-16), respectively. SARS-CoV-2 neutralizing antibodies exceeded the threshold for neutralization in 4/22 (18%) dialysis patients compared with 43/46 (93%) in healthy controls, with a median (IQR) percent inhibition of 11 (3-24) compared with 65 (49-75), respectively. After the second dose, 14/17 (82%) of dialysis patients developed neutralizing antibodies exceeding the threshold for viral neutralization and antibodies against the receptor-binding S1-domain of the spike protein, compared to 46/46 (100%) of healthy controls, respectively. The median (IQR) percent inhibition was 51 (32-86) compared to 98 (97-98) in healthy controls. Conclusions Patients receiving long-term hemodialysis show a reduced antibody response to the first and second doses of the mRNA vaccine BNT162b2. The majority (82%) develop neutralizing antibodies after the second dose, but at lower levels than healthy controls.

Mass Disasters and Burnout in Nephrology Personnel

Sever, Mehmet Sukru — Thu, 07 Jan 2021 09:39:06 GMT-08:00

Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.

COVID-19: A Home Dialysis Nurse Perspective

Bushey, Margaret — Thu, 04 Jun 2020 01:34:49 GMT-07:00

The Immunocompromised Transplant Recipient and SARS-CoV-2 Infection

Fishman, Jay A. — Tue, 28 Apr 2020 02:53:06 GMT-07:00

Providing Care to Patients with AKI and COVID-19 Infection: Experience of Front Line Nephrologists in New York

Fisher, Molly — Wed, 06 May 2020 01:43:10 GMT-07:00

COVID-19 and the Inpatient Dialysis Unit

Burgner, Anna — Fri, 03 Apr 2020 02:54:11 GMT-07:00

How COVID-19 Has Changed the Management of Glomerular Diseases

Bomback, Andrew S. — Fri, 24 Apr 2020 04:43:33 GMT-07:00

Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

d-batlle@northwestern.edu — Mon, 14 Jun 2021 12:53:52 GMT-07:00

Despite evidence of multi-organ tropism of SARS-CoV-2 in patients with COVID-19, direct viral kidney invasion has been difficult to demonstrate. The question of whether SARS-CoV-2 can directly infect the kidney is relevant to the understanding of pathogenesis of acute kidney injury and collapsing glomerulopathy in COVID-19. Methodologies to document SARS-CoV-2 infection that have been used include immunohistochemistry, immunofluorescence, reverse transcriptase polymerase chain reaction (RT-PCR), in situ hybridization and electron microscopy. In our review of studies to date we found that SARS-CoV-2 in the kidney of patients with COVID-19 was detected in 18 of 94 (19%) by immuno-histochemistry, 71 of 144 (49%) by RT-PCR and 11 of 84 (13%) by in situ hybridization. In a smaller number of patients with COVID-19 examined by immunofluorescence, SARS-CoV-2 was detected in 10 of 13 (77%). In total, in kidneys from 102 of 235 patients (43.4%), the presence of SARS-CoV-2 was suggested by at least one of the methods used. Despite these positive findings, caution is needed as many other studies have been negative for SARS-CoV-2 presence and it should be noted that when detected it was only in kidneys obtained at autopsy. There is a clear need for studies from kidney biopsies, including those performed at early stages of the COVID-19 associated kidney disease. Development of tests to detect kidney viral infection in urine samples would be more practical as a non-invasive way to evaluate SARS CoV-2 infection during the evolution of COVID-19-associated kidney disease.

COVID-19 and AKI: Where Do We Stand?

Palevsky, Paul M. — Fri, 26 Feb 2021 10:17:36 GMT-08:00

Meeting the Demand for Renal Replacement Therapy during the COVID-19 Pandemic: A Manufacturer’s Perspective

Anger, Michael S. — Tue, 29 Dec 2020 01:46:37 GMT-08:00

Technology, Telehealth, and Nephrology: The Time Is Now

Jain, Gaurav — Wed, 03 Jun 2020 10:15:34 GMT-07:00

Impending Shortages of Kidney Replacement Therapy for COVID-19 Patients

Goldfarb, David S. — Tue, 28 Apr 2020 06:21:15 GMT-07:00

Early Use of Telehealth in Home Dialysis during the COVID-19 Pandemic in New York City

Srivatana, Vesh — Tue, 28 Apr 2020 09:39:51 GMT-07:00

Authors' Reply

Clarke, Candice L. — Tue, 29 Sep 2020 11:07:03 GMT-07:00

Mitigating Risk of COVID-19 in Dialysis Facilities

Kliger, Alan S. — Fri, 20 Mar 2020 01:20:05 GMT-07:00

Nephrology—Taking the Lead

Agarwal, Anupam — Mon, 01 Mar 2021 06:01:34 GMT-08:00

COVID-19 and APOL1: Understanding Disease Mechanisms through Clinical Observation

Friedman, David J. — Mon, 07 Dec 2020 08:43:40 GMT-08:00

Long-Term Hemodialysis during the COVID-19 Pandemic

Gedney, Nieltje — Thu, 02 Jul 2020 07:49:00 GMT-07:00

CKRT Clotting and Cerebrovascular Accident in a Critically Ill Patient

Cervantes, Carmen Elena — Thu, 30 Jul 2020 05:30:20 GMT-07:00

Disaster Response to the COVID-19 Pandemic for Patients with Kidney Disease in New York City

Thu, 04 Jun 2020 05:58:30 GMT-07:00

Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology

Batlle, Daniel — Mon, 04 May 2020 10:56:16 GMT-07:00

On the Frontline of the COVID-19 Outbreak

Watnick, Suzanne — Sat, 28 Mar 2020 07:24:34 GMT-07:00

COVID-19, Racism, and Racial Disparities in Kidney Disease: Galvanizing the Kidney Community Response

Crews, Deidra C. — Mon, 13 Jul 2020 11:02:22 GMT-07:00

This article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2020_07_21_JASN2020060809.mp3

Effect of COVID-19 on Kidney Disease Incidence and Management

McAdams, Meredith — Tue, 24 Nov 2020 10:19:10 GMT-08:00

The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus’s effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.

mRNA COVID-19 Vaccine for People with Kidney Failure

dmiskulin@cjasn.org — Thu, 27 May 2021 09:25:51 GMT-07:00

Authors’ Reply

Adamsick, Meagan L. — Thu, 21 Jan 2021 10:45:07 GMT-08:00

Humoral Response after SARS-Cov-2 mRNA Vaccine in a Cohort of Hemodialysis Patients and Kidney Transplant Recipients

Fatouma.TOURE@chu-limoges.fr — Wed, 16 Jun 2021 10:31:16 GMT-07:00

Background Kidney transplant recipients and patients receiving hemodialysis are immunocompromised populations that are prioritized for COVID-19 vaccination but were excluded from clinical trials of SARS-CoV-2 mRNA vaccines. Antibody titers and rates of seroconversion following vaccination are lower among patients with chronic kidney disease and those taking immunosuppressants compared with controls. Data are lacking regarding their humoral response to vaccination to prevent COVID-19. Methods This investigation of early serological response after COVID-19 vaccination with the Pfizer/BioNTech (BNT162b2) mRNA vaccine included 78 patients undergoing hemodialysis, 74 kidney transplant recipients, and 7 healthy controls. We recorded data from the medical file for various clinical parameters, including response to hepatitis B vaccination, and measured antibody titers against SARS-CoV-2 at 0, 14, 28, 36 and 58 days after the first injection. Results In controls, we detected antibodies at a positive level (>13 arbitrary units per milliliter [AU/ml]) at day 14 postinjection, which increased progressively to peak at day 36 (1082 AU/ml; interquartile range [IQR], 735.0-1662.0]). Patients undergoing hemodialysis had lower titers that peaked at day 58 (276 AU/ml [IQR, 83.4-526.0]. We detected a positive antibody level in only three transplant recipients at day 36. In hemodialysis patients, those younger than 75 years had a higher antibody response versus those older than 75 years and serum albumin and Kt/V were positively correlated with serological response (P< 0.043 and P<0.019, respectively); nonresponders to HBV vaccine had the lowest anti-SARS-CoV-2 antibody titers. Conclusions Our results suggest that the postvaccination humoral response is strongly inhibited by immunosuppressant therapy in kidney transplant recipients and is reduced by the uremic condition in patients undergoing hemodialysis.

Vaccine and the Need to be Heard: Considerations for COVID-19 immunization in ESRD

ves2009@nyp.org — Thu, 08 Apr 2021 01:50:57 GMT-07:00

This is an Early Access article. Please select the PDF button, above, to view it.

Remdesivir in COVID-19 Patients with Impaired Renal Function

Gevers, Sanna — Thu, 21 Jan 2021 10:45:06 GMT-08:00

The Early Days

Roberts, Glenda V. — Wed, 29 Jul 2020 08:58:42 GMT-07:00

The Characteristics, Dynamics, and the Risk of Death in COVID-19 Positive Dialysis Patients in London, UK

Kular, Dalvir — Thu, 10 Sep 2020 08:21:38 GMT-07:00

Vaccines and Disease Relapses in Children with Nephrotic Syndrome

Angeletti, Andrea — Fri, 11 Jun 2021 12:06:56 GMT-07:00

COVID-19 and Dialysis Patients: Unsolved Problems in Early 2021

Kliger, Alan S. — Fri, 26 Feb 2021 10:17:36 GMT-08:00

SARS-CoV-2 Vaccines in Kidney Transplant Recipients: Will They Be Safe and Effective and How Will We Know?

Heldman, Madeleine R. — Wed, 24 Mar 2021 07:54:56 GMT-07:00

Authors’ Reply

Farkash, Evan A. — Wed, 12 Aug 2020 05:49:14 GMT-07:00

Counterpoint: Twice-Weekly Hemodialysis Should Be an Approach of Last Resort Even in Times of Dialysis Unit Stress

Mehrotra, Rajnish — Thu, 16 Apr 2020 06:17:58 GMT-07:00

Beware the Ides of March: A Fellow’s Perspective on Surviving the COVID-19 Pandemic

Hindi, Judy — Thu, 24 Sep 2020 01:29:45 GMT-07:00

Kidney Involvement in COVID-19: Need for Better Definitions

Delsante, Marco — Thu, 09 Jul 2020 07:56:55 GMT-07:00

Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic

Carson, Rachel C. — Mon, 08 Feb 2021 09:47:52 GMT-08:00

The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supplies and equipment around the world. Resource allocation in times of scarcity requires transparent, ethical frameworks to optimize decision making and reduce health care worker and patient distress. The complexity of allocating dialysis resources for both patients receiving acute and maintenance dialysis has not previously been addressed. Using a rapid, collaborative, and iterative process, BC Renal, a provincial network in Canada, engaged patients, doctors, ethicists, administrators, and nurses to develop a framework for addressing system capacity, communication challenges, and allocation decisions. The guiding ethical principles that underpin this framework are (1) maximizing benefits, (2) treating people fairly, (3) prioritizing the worst-off individuals, and (4) procedural justice. Algorithms to support resource allocation and triage of patients were tested using simulations, and the final framework was reviewed and endorsed by members of the provincial nephrology community. The unique aspects of this allocation framework are the consideration of two diverse patient groups who require dialysis (acute and maintenance), and the application of two allocation criteria (urgency and prognosis) to each group in a sequential matrix. We acknowledge the context of the Canadian health care system, and a universal payer in which this framework was developed. The intention is to promote fair decision making and to maintain an equitable reallocation of limited resources for a complex problem during a pandemic.

Lessons from the Experience in Wuhan to Reduce Risk of COVID-19 Infection in Patients Undergoing Long-Term Hemodialysis

Li, Junhua — Thu, 02 Apr 2020 01:32:19 GMT-07:00

Caution in Identifying Coronaviruses by Electron Microscopy

Miller, Sarah E. — Fri, 10 Jul 2020 10:44:14 GMT-07:00