Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States
Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States
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DOI：
10.1053/j.ajkd.2020.07.005
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发表时间：
2020-11-01
影响因子：
13.2
通讯作者：
Reddy, Krishna P.
中科院分区：
文献类型：
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作者：
Reddy, Yuvaram N., V;Walensky, Rochelle P.;Reddy, Krishna P.
理论与目的：在2019年新冠肺炎大流行期间，纽约遇到了持续肾脏替代疗法(CKRT)能力短缺的问题，该疗法适用于急性肾损伤3期需要透析的危重患者。为了为当前和未来的危机制定计划，我们估计了美国新冠肺炎大流行期间的中广铁路需求和运力。研究设计：我们开发了数学模型来预测全国和全州的中广铁路需求和运力。数据来源包括健康指标与评估研究所的模型、哈佛全球卫生研究所的模型和已发表的文献。地点和人口：美国患者在新冠肺炎大流行的第一波期间(2020年2月6日至2020年8月4日)住院。干预：CKRT。结果：CKRT资源使用高峰时的需求和能力；预计将遇到CKRT短缺的州的数量。模型、视角和时间框架：卫生部门的视角，时间跨度为6个月。结果：在基本情况模型假设下，全国CKRT能力为7,032台机器，估计短缺1,088台(95%不确定区间，910-1,568)台机器，6个州在资源使用高峰时短缺。在敏感性分析中，围绕以下方面的不同假设：(1)新冠肺炎前可用的剩余CKRT机器的数量和(2)住院的新冠肺炎患者中需要进行CKRT治疗的急性肾损伤3期的发生率分别导致3至8个州(933-1,282台机器)和4至8个州(945-1,723台机器)的预计短缺。在最好和最坏的情况下，有3个州和26个州(614台和4,540台机器)出现了短缺。限制：参数估计受到在缺乏已公布数据的情况下所做的假设以及健康指标与评估研究所模型的局限性的影响。结论：美国几个州预计在新冠肺炎大流行期间将遇到中央研究院的短缺。这些发现虽然基于有限的慢性肾移植需求和能力的数据，但表明在医疗危机期间，如新冠肺炎大流行，建立住院肾脏替代疗法国家登记和维持国家慢性肾移植设备库存是有价值的。
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.