Abstract: PO0662
Forecasting Continuous Renal Replacement Therapy Shortages During the COVID-19 Pandemic in the United States
Session Information
- COVID-19: AKI and Outcomes
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Reddy, Yuvaram N.V., Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Walensky, Rochelle P., Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States
- Reddy, Krishna P., Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
Background
The coronavirus disease 2019 (COVID-19) pandemic has increased continuous renal replacement therapy (CRRT) demand in the US, however total CRRT demand and capacity remain unclear. Our objective was to project national and statewide CRRT demand and capacity during the COVID-19 pandemic.
Methods
We projected CRRT demand using a model in which 4% of patients admitted with COVID-19 develop acute kidney injury (AKI) requiring CRRT for 12 days. To estimate non-COVID-19 CRRT demand, we applied the prevalence of AKI requiring CRRT among other ICU patients of 8.8%. We assumed capacity would be double this demand and that this demand would decrease to 25% during the pandemic. We compared CRRT demand and capacity to estimate shortage. In sensitivity analysis, we varied parameters influencing CRRT demand and capacity.
Results
We estimated a national CRRT shortage of 1529 (95% uncertainty interval:1264-3837) machines with a capacity of 9375 machines, and shortages in 8 states during the COVID-19 pandemic (Table 1 and Figure 1).
Conclusion
Several US states are projected to have CRRT shortages during the COVID-19 pandemic. A national strategy, such as the creation of a federal stockpile, is needed to mitigate CRRT shortages during this pandemic and future healthcare crises.
Model-generated results for 8 states with CRRT shortages
| State | Total ICU beds | Occupied ICU beds | Pre-COVID-19 CRRT demand | CRRT capacity | CRRT demand at peak resource utilization (95% uncertainty interval) | CRRT shortage at peak resource utilization (95% uncertainty interval) |
| Connecticut | 731 | 446 | 39 | 78 | 224 (171-503) | 146 (92-425) |
| Maryland | 1227 | 805 | 71 | 142 | 174 (128-391) | 32 (0-249) |
| Massachusetts | 1555 | 984 | 87 | 173 | 193 (143-464) | 20 (0-291) |
| Michigan | 2749 | 1773 | 156 | 312 | 313 (293-429) | 1 (0-117) |
| New Jersey | 1891 | 1045 | 92 | 184 | 575 (514-1011) | 391 (330-827) |
| New York | 4420 | 2750 | 242 | 484 | 1391 (1325-1565) | 907 (841-1081) |
| Rhode Island | 279 | 202 | 18 | 36 | 51 (24-207) | 15 (0-171) |
| Wyoming | 102 | 37 | 3 | 7 | 23 (2-114) | 17 (0-107) |
| As noted, 8 US states are projected to encounter CRRT shortages with a total shortage of 1529 (95% uncertainty interval:1264-3837) machines during the COVID-19 pandemic. Minor discrepancies in this table are due to rounding. | ||||||
Heat maps demonstrating states with CRRT shortages during the COVID-19 pandemic under scenarios: A) base case, B) highest CRRT capacity estimate and C) lowest CRRT capacity estimate
Funding
- NIDDK Support