Table 1.

Impediments to delivery of adequate KRT

High incidence of AKI in affected patients
 Responses
  Anticipatory contingency planning (3,5)
  Regular virtual meetings and calls with administrators to review workload and needs
Loss of hemodialysis personnel to COVID-19
 Responses
  Initiate more CKRT
  Initiate acute peritoneal dialysis
  Train nonhemodialysis staff
  Recruit volunteers
  Safely reduce frequency and duration of hemodialysis for patients with kidney failure
  Transfer of patients with hemodialysis from hospital-based units to community dialysis units
Relative inexperience of some personnel with placement of peritoneal dialysis catheters
 Responses
  Encourage surgeons, radiologists, and nephrologists with experience to train additional staff
Relative inexperience of ICU staff and dialysis staff with performance of peritoneal dialysis
 Responses
  Construct teams of non-ICU, nondialysis staff to help manage manual exchanges
  Obtain cyclers to help automate exchanges and reduce risks of staff exposures
Shortages of supplies of KRT supplies
 High national and local demands put stress on vendors
 CKRT machines, cartridges, and fluid
 Hypercoagulability leads to loss of cartridges and lines
 Peritoneal dialysis fluid
 Responses
  Develop relationships with vendors to anticipate needs and ensure delivery of equipment and supplies
  Perform accelerated venovenous hemofiltration to get two treatments per day from each CKRT machine if sufficient supply of cartridges is available
  Perform fewer peritoneal fluid exchanges as blood values correct
Resistance of overworked staff to learning new procedures or use of new equipment
 Responses
  Be patient, constructive, and collaborative in developing teams
  • COVID-19, novel coronavirus 2019; ICU, intensive care unit; CKRT, continuous kidney replacement therapy.