Despite strategic planning, during the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT). To improve future planning, we developed mathematical models to project CKRT demand and capacity in the United States by state. The models projected shortages in 6 states during the initial wave of the COVID-19 pandemic, with possible shortages in 8 additional states. Currently, these models are based on limited data on CKRT demand and capacity across the United States. Due to uncertainty in the parameters used in the model, shortages varied between 3 and 26 states in the best-case and worst-case scenarios. This limitation highlights the potential value of collecting national data on dialysis machines, supplies, and personnel using an inpatient kidney replacement therapy national registry and the creation of a national stockpile of CKRT equipment.
The COVID-19 pandemic has increased continuous kidney replacement therapy (CKRT) demand in the US. To inform planning and mitigate CKRT shortages, we sought to project nationwide and statewide CKRT demand and capacity during the COVID-19 pandemic.
We projected CKRT demand using models in which 5.2% of patients admitted with COVID-19 develop AKI requiring CKRT for 6 days. To estimate non-COVID-19 CKRT demand, we applied the prevalence of AKI requiring CKRT among other ICU patients of 8.8%. We assumed capacity would be 150% this demand and that this demand would decrease to 40% during the pandemic. We compared CKRT demand and capacity to estimate shortage. In sensitivity analysis, we varied parameters influencing CKRT demand and capacity.
We estimated a nationwide CKRT shortage of 1,088 (95% uncertainty interval:910-1,568) machines with a capacity of 7,032 machines, and shortages in 6 states during the COVID-19 pandemic. In the best-case and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines).
Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. National strategies – such as a national CKRT stockpile – are needed to mitigate CKRT shortages during this pandemic and future healthcare crises.