The Aftermath of Coronavirus Disease 2019

Devastation or a New Dawn for Nephrology?

Rajiv Agarwal


Nephrol Dial Transplant. 2020;35(6):904-907. 

In This Article

Dialysis Delivery

COVID-19, being a droplet-borne viral infection, necessitated social distancing and required patients to be dialyzed in a manner that reduced the risk of viral transmission to other dialysis patients in the same unit. One option was to dialyze such patients at home. Thus home-based systems—instead of in-center dialysis requiring centralized water delivery systems—may emerge. Receiving self-care dialysis during catastrophes may make more sense for our patients and may enter the lexicon when planning care for patients reaching end-stage renal disease. Patients may therefore lean toward home therapies such as peritoneal dialysis or home hemodialysis, instead of in-center dialysis.

The increase in patients with multi-organ failure requiring acute dialysis posed another challenge to the system. Acute peritoneal dialysis has not been adopted in dialysis units, but the scarcity of resources led to resurrection of a technique that had almost been forgotten. Low-volume continuos veno-venous hemofiltration (CVVH) delivery was adopted due to the adequate supply of replacement solutions. Whether such interventions help or hurt can only be answered by future analyses, and even then, causality would be difficult to deduce. However, such data may challenge the paradigm of high-volume CVVH currently practiced.

The push to monitor the patient remotely without entering the room was acutely felt during this epidemic. Baby monitors were installed in patient's rooms to communicate with patients. Given that acute respiratory distress syndrome was an important feature of the disease, the need to monitor vital signs was never felt more acutely. These needs may drive innovation in remote monitoring systems that may benefit dialysis patients directly by noninvasively monitoring the hemodynamic state on a beat-to-beat basis.