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

Abstract

Rationale Objective

During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis (AKI 3D). 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 (IHME) model, the Harvard Global Health Institute model, and published literature.

Setting

Population: US patients hospitalized during the initial wave of the COVID-19 pandemic (02/06/2020 to 08/04/2020).

Intervention

CKRT.

Outcomes

CKRT demand and capacity at peak resource utilization; 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 utilization. In sensitivity analyses, varying assumptions around (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of AKI 3D requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3-8 states (933-1,282 machines) and 4-8 states (945-1,723 machines), respectively. In the best-case 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 on CKRT capacity and by the IHME model’s limitations.

Conclusions

Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings – while based on limited data on 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.

Index Words

Continuous renal replacement therapy (CKRT), coronavirus disease 2019 (COVID-19), acute kidney injury (AKI), acute kidney injury stage 3 requiring dialysis (AKI 3D), shortages, mathematical model.