COVID-19: Renal Association President’s Briefing 02 April 2020
In the midst of the biggest social and medical upheaval in our lifetimes, disproportionate impact on our patients and whilst many of us become ill, we can be proud of the cohesion, leadership and remarkably agile delivery from all across our renal community.
The RA working collaboratively has developed resources and will continue practical support for clinicians and patients. I thank you for your dedication to these resources below:
- Renal Care COVID19 Guidance: Organisation of service delivery, Commentary on urgent NHSE NICE Dialysis service delivery (with BRS), stratification risk and management of renal patients on immunosuppression (with RCP), management of transplant recipients (with BTS) and a number of Rare Disease guides (pregnancy & TSC)
- Patient information– regularly updated (led by Kidney Care UK and National Kidney Federation).
- ESKD COVID registry data and outcomes to units weekly across UK (RA Registry)
- Regional network support (registry KQuIP project managers) to clinicians with NHSE. NHSE have appointed regional medical leads which is great progress.
- Sharing-Renal COVID19 Guidance Group TC with 40 weekly attendees, register here.
- Collection or external resources, links and key papers
Speaking to many of you I want to highlight urgent challenges ahead on which we will work jointly with you to overcome:
- Haemodialysis cohorting: practical guidance whilst reduced staffing, through regional networks
- HD patient transport has been a major challenge-new developments from NHSE
- Early rapid COVID ESKD patient and staff testing of IP and OP is urgently needed
- ESKD-access to critical care. NICE Critical Care Guidance and clinical frailty scoring is supportive but we must also rely on evidence to avoid discrimination in access of patients with ESKD in to ventilation. ESKD must not alone be considered a contraindication to ventilation
- End of life care ethics and support-tragically for those who will not benefit from treatment escalation we must ensure advanced care planning & use excellent palliative care resources
- ITU AKI care requirement: modelling of need and ensure adequate provision for massive planned ITUs expansion.
- Patient shielding support: designation of ESKD patients as highly vulnerable provides significant benefits to them. The central plan to write to all transplant recipients is incomplete. All units should promptly contact transplant and dialysis patients asking them to self-register. Dialysis patients can use the criteria of having a rare disease or condition which increases the risk of infection
- Service delivery reduction planning; adult renal transplantation has temporarily almost ceased. Preparation to select patients to reduce dialysis frequency should be taken but actual dialysis frequency reduction should be a system decision guided by clinicians and involving the Trust, regional NHSE leads and commissioners so that all alternatives have been considered and addressed. Please inform RA if after all local and regional clinical mitigation you are informed by management to reduce dialysis frequency
Trainees and our multi-professional colleagues in particular face major disruption in training, reallocation into new areas of practice, long hours and risk illness despite adequate PPE. We must ensure we plan practical and emotional support for our trainees, multi-professional team colleagues and for each other.
I wish to thank you all and wish you well.
The renal family will prevail, we will support one another and learn lessons to emerge even stronger.
Please contact me to discuss any issues President@renal.org