These recommendations are based on the guidance released by American Society of Nephrology.

PATIENT CARE

• Patients will be co-located on a floor based on the policies of the institution/organization.
• Nephrologists, dialysis and ICU staff will follow the government recommendations regarding PPE and safety guidelines during their interactions with the patient.
• Nephrologists should consider reducing or avoiding daily patient contact by collaborating with primary physician and depending on them to convey relevant physical exam and ultrasound findings, such as volume status. Organizations may have their own guidelines to reduce exposure for the providers.
• Indications to start renal replacement therapy are like other patients with acute kidney injury. Loop diuretics may be used in the management of volume overload, based on the clinical judgment of the treating physician.
• If patients develop indications to initiate renal replacement therapy or if an ESRD patient needs a dialysis catheter for vascular access, this will be placed by a physician with the most expertise in placement of central venous catheters. This may also include the involvement of general surgery or radiology consultation.

MANAGEMENT OF RENAL REPLACEMENT THERAPY

• Typically, patients with acute kidney injury whoa re not admitted to the ICU are transported to a central acute dialysis unit for treatment. This is not recommended in the setting of active or suspected COVID 19.
• If hospitals are utilizing individual negative pressure rooms to take care of COVID 19 patients, then they will need 1:1 hemodialysis nursing for IHD in their rooms.
• If hospitals have isolated all COVID 19 patients in one floor, then one dialysis nurse may be able to monitor 2 or 3 patients during IHD, if video and electronic monitoring is available in the IMMEIDATE vicinity. The nurse will enter the room for trouble shooting the machine or if the patient needs asssitanc.
• To reduce exposure to dialysis staff, other equipment can be utilized to provide therapy on the hospital floor.
• Due to cancelation of elective procedures, non-acute care and non-dialysis nurses may be recruited to monitor patients undergoing renal replacement therapy, with the supervision of an ICU or dialysis nurse.

Resource:

Recommendations on the care of hospitalized patients with COVID-19 and kidney failure requiring renal replacement therapy. American Society of Nephrology. 21 March 2020. Accessed on: April 4 2020. Accessed from: https://www.asn-online.org/g/blast/files/AKI_COVID-19_Recommendations_Document_03.21.2020.pdf