FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3089968146> ?p ?o ?g. }

• W3089968146 endingPage "1433" @default.
• W3089968146 startingPage "1424" @default.
• W3089968146 abstract "The coronavirus disease 2019 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes in policy and practice affect the ability of all health professionals to fulfill their ethical duties toward their patients in providing best practice care. In this article, we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decision-making; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them. The coronavirus disease 2019 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes in policy and practice affect the ability of all health professionals to fulfill their ethical duties toward their patients in providing best practice care. In this article, we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decision-making; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them. Editor’s NoteThis is one of several articles we think you will find of interest that are part of our special issue of Kidney International addressing the challenges of dialysis and transplantation during the COVID-19 pandemic. Please also find additional material in our commentaries and letters to the editor sections. We hope these insights will help you in the daily care of your own patients. This is one of several articles we think you will find of interest that are part of our special issue of Kidney International addressing the challenges of dialysis and transplantation during the COVID-19 pandemic. Please also find additional material in our commentaries and letters to the editor sections. We hope these insights will help you in the daily care of your own patients. The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas. The pandemic has profoundly affected delivery of essential health services, including care for patients with or at risk of kidney disease. Measures to reduce infection risk have changed the way care is delivered, creating potential difficulties for health professionals in fulfilling their ethical responsibilities toward individual patients, public health, and their own families (see Table 1).1Bakewell F. Pauls M.A. Migneault D. Ethical considerations of the duty to care and physician safety in the COVID-19 pandemic.CJEM. 2020; 22: 407-410Crossref PubMed Scopus (21) Google Scholar, 2Binkley C.E. Kemp D.S. Ethical rationing of personal protective equipment to minimize moral residue during the COVID-19 pandemic.J Am Coll Surgeons. 2020; 230: 1111-1113Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 3Kliger A.S. Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities.Clin J Am Soc Nephrol. 2020; 15: 707-709Crossref PubMed Scopus (137) Google Scholar, 4Ying NL, Kin W, Han LC, et al. Rapid transition to a telemedicine service at Singapore community dialysis centers during Covid-19 [e-pub ahead of print]. NEJM Catal Innov Care Deliv. https://doi.org/10.1056/CAT.20.0145. Accessed August 23, 2020.Google Scholar For patients with kidney failure (KF), who are dependent for survival on access to kidney replacement therapy (KRT) in the form of transplantation or dialysis, some changes have high-stakes implications. In settings where access to care was already difficult, the disruption of COVID-19 has proven catastrophic for some patients.5Ramachandran R. Jha V. Adding insult to injury: kidney replacement therapy during COVID-19 in India.Kidney Int. 2020; 98: 238-239Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar COVID-19 infection is associated with the development of nephropathy and acute kidney injury (AKI), increasing demand for dialysis during surge periods.6Goldfarb D.S. Benstein J.A. Zhdanova O. et al.Impending shortages of kidney replacement therapy for COVID-19 patients.Clin J Am Soc Nephrol. 2020; 15: 880-882Crossref PubMed Scopus (87) Google Scholar, 7Perico L. Benigni A. Remuzzi G. Should COVID-19 concern nephrologists? Why and to what extent? The emerging impasse of angiotensin blockade.Nephron. 2020; 144: 213-221Crossref PubMed Scopus (233) Google Scholar, 8Naicker S. Yang C.W. Hwang S.J. et al.The novel coronavirus 2019 epidemic and kidneys.Kidney Int. 2020; 97: 824-828Abstract Full Text Full Text PDF PubMed Scopus (438) Google Scholar, 9Kulish N. A life and death battle: 4 days of kidney failure but no dialysis. The New York Times.https://www.nytimes.com/2020/05/01/health/coronavirus-dialysis-death.htmlDate accessed: May 8, 2020Google Scholar, 10Abelson R. Fink S. Kulish N. Thomas K. An overlooked, possibly fatal coronavirus crisis: a dire need for kidney dialysis. The New York Times.https://www.nytimes.com/2020/04/18/health/kidney-dialysis-coronavirus.htmlDate accessed: May 8, 2020Google Scholar Kidney transplant patients are more vulnerable to severe complications of COVID-19,11Gandolfini I. Delsante M. Fiaccadori E. et al.COVID-19 in kidney transplant recipients.Am J Transplant. 2020; 20: 1941-1943Crossref PubMed Scopus (155) Google Scholar and transplant and dialysis patients may be at higher risk of infection.11Gandolfini I. Delsante M. Fiaccadori E. et al.COVID-19 in kidney transplant recipients.Am J Transplant. 2020; 20: 1941-1943Crossref PubMed Scopus (155) Google Scholar, 12Ikizler T.A. Kliger A.S. Minimizing the risk of COVID-19 among patients on dialysis.Nat Rev Nephrol. 2020; 16: 311-313Crossref PubMed Scopus (72) Google Scholar, 13Kliger A.S. Cozzolino M. Jha V. et al.Managing the COVID-19 pandemic: international comparisons in dialysis patients.Kidney Int. 2020; 98: 12-16Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 14Trujillo H. Caravaca-Fontán F. Sevillano Á. et al.SARS-CoV-2 infection in hospitalized patients with kidney disease.Kidney Int Rep. 2020; 5: 905-909Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar People with kidney disease and transplant recipients have a higher risk of death from COVID-19.15The OpenSAFELY Collaborative, Williamson E, Walker AJ, Bhaskaran KJ, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients [e-pub ahead of print]. medRxiv. https://doi.org/10.1101/2020.05.06.20092999. Accessed August 23, 2020.Google ScholarTable 1Challenges fulfilling ethical duties in the context of changes in health care deliveryEthical dutiesChallengesStrategies▪Respect for autonomy: A competent person’s right to govern their own life and make informed and voluntary decisions about their care in accordance with their values and preferences.▪Increased use of telemedicine means there may be barriers to effective communication and shared decision-making, especially for patients with additional communication barriers (e.g., language, culture, hearing/visual impairment, and cognitive impairment).▪Concerns about the sufficiency of informed consent given uncertain evidence base for decision-making.▪Limitations on carers/family accompanying or visiting patients.▪Use communication aids; additional support and training for staff, carers, and patients in technology use; investment in resources to facilitate timely communication.▪Be transparent in communication of information and consideration of limits of knowledge.▪Ensure that ethical oversight and procedures used to support informed consent and risk management are used in all clinical care and research activities.▪Respect for privacy and confidentiality: A person’s right to govern access to their person and personal information, including rights to determine how information is used and by whom.▪There may be an increase in health data collection and greater demand for monitoring and use of individual health data to inform practice and manage risks of infection to public health.▪Obtaining informed consent on collection and use of personal data from patients may be difficult because of time constraints. Tensions may arise if patients refuse collection or use of data when this is required by public health law.▪Ensure public health policies are clearly communicated to patients including information on rights and responsibilities with respect to privacy of health data. Potential benefits of monitoring/data use for patients should also be communicated.▪Respect for beneficence and nonmaleficence: Obligations to promote the well-being of patients and public health, to avoid causing harm, and to ensure that when harm is unavoidable it is proportionate to the expected benefits of an action.▪Uncertainties regarding the risks and benefits of treatment options and strategies to manage risk of COVID-19 infection.▪Limitations of increased use of telemedicine.▪Physical distancing and use of PPE.▪Reduced availability of staff. This may lead to deployment of staff to areas of practice outside their scope of expertise may cause some to feel less competent in providing best practice care.▪Disruption to supply of health resources (e.g., dialysis).▪Measures to reduce infection risks may result in delays in access to or delivery of care (e.g., staff taking time to don PPE before commencing cardiopulmonary resuscitation) or reduced quality of care considered to be best practice (e.g., by impairing nonverbal communication during end-of-life care).▪Limited supply of health resources may require compromises in quality of care and/or withholding of treatment if rationing is necessary (see below).▪Ensure adequate and accessible supply of PPE for health care workers to minimize the risk of harm to them (and resulting loss of resources), patients, and the public.▪Provide training and support to staff working in unfamiliar areas.▪Develop and disseminate guidelines to support decision-making when usual processes/standards of care must be adapted to meet constraints of pandemic environment.▪Engage patients and their families in discussions so they are able to express their values and preferences when making decisions related to risk-benefit calculations.▪Inform patients of conflicting duties between patient and public health so that changes in care provider or decisions that entail limitation of care are not interpreted as abandonment, and ensure patients are assured of ongoing care. Use additional resources where available to mitigate risks (e.g., remote monitoring to support telemedicine).▪Duty of fidelity: Obligation to be loyal to one’s patient, prioritizing their well-being over other interests and committing to ongoing provision of care.▪Conflicts may arise between duty of care to an individual patient and obligations to protect public health and/or to provide care to patients and to protect oneself and one’s family.▪Insufficient supply of resources may lead to rationing, which requires treatment to be withheld or withdrawn from a patient.▪High staff turnover (e.g., because of infection and/or redeployment) may result in disruption to continuity of care.▪Recognize potential effect of challenges on health care workers and provide support.▪Respect health professionals’ interests, including their interest in protecting themselves and their families.▪Respect for human dignity: Acknowledgment of the equal and inherent moral value of individual persons, encompassing the fundamental right to health and to be treated always as an end in oneself and never merely as a means to the ends of others.▪Particular populations may be vulnerable to neglect because of barriers in accessing regular care (e.g., elderly in nursing homes).▪Rationing frequently negatively affects those whose lives may be wrongly considered less valuable (e.g., people with disabilities).▪Health care workers may also be at risk of being used as a means to an end, rather than recognized as inherently valuable.▪Consider implications of rationing approaches that may discriminate unfairly against those who are already disadvantaged (i.e., when evaluating quality of life).▪Give voice to those groups who may be overlooked.▪Respect for justice: Obligation to act and make decisions impartially, ensuring that where inequalities are unavoidable, these are fair and hence equitable, and determined by transparent and justifiable criteria that are open to scrutiny.▪Insufficiency of resources to meet surging demand.▪Decisions being made that affect large populations rather than just individuals and hence the need for fairness in decision-making.▪Reliance on telemedicine and changes in treatment modalities may exacerbate inequities in access to care for patients who face barriers (e.g., poor health literacy and lack of Internet resources) to use of particular technologies.▪Ensure that all processes and guidelines are evidence based, transparent, and that there is accountability.▪Ensure that ethical guidelines consider stakeholder values and preferences and that principles are consistently applied. Include stakeholders in decision-making about resource allocation and communicate such decisions to all those affected.▪Identify and strive to address potential barriers to accessing care—whether in person or via telemedicine—which may affect specific populations.COVID-19, coronavirus disease 2019; PPE, personal protective equipment. Open table in a new tab COVID-19, coronavirus disease 2019; PPE, personal protective equipment. Awareness of the effect of the pandemic on access to dialysis is growing,9Kulish N. A life and death battle: 4 days of kidney failure but no dialysis. The New York Times.https://www.nytimes.com/2020/05/01/health/coronavirus-dialysis-death.htmlDate accessed: May 8, 2020Google Scholar,10Abelson R. Fink S. Kulish N. Thomas K. An overlooked, possibly fatal coronavirus crisis: a dire need for kidney dialysis. The New York Times.https://www.nytimes.com/2020/04/18/health/kidney-dialysis-coronavirus.htmlDate accessed: May 8, 2020Google Scholar and professional societies have publicly called for action to address issues in kidney care during the pandemic.16American Society of Nephrology, European Renal Association-European Dialysis and Transplant Association, International Society of NephrologyEnsuring optimal care for people with kidney diseases during the COVID-19 pandemic.https://www.kidneynews.org/sites/default/files/Statement%20ASN%20ERA%20EDTA%20ISN%204.28.20.pdfDate accessed: May 8, 2020Google Scholar However, despite several publications offering ethical advice during the pandemic, most focus on long-standing ethical concerns in the context of pandemics, such as obligations of health care workers to provide care and the allocation of scarce resources, in particular personal protective equipment, ventilators, and antiviral medications.1Bakewell F. Pauls M.A. Migneault D. Ethical considerations of the duty to care and physician safety in the COVID-19 pandemic.CJEM. 2020; 22: 407-410Crossref PubMed Scopus (21) Google Scholar,2Binkley C.E. Kemp D.S. Ethical rationing of personal protective equipment to minimize moral residue during the COVID-19 pandemic.J Am Coll Surgeons. 2020; 230: 1111-1113Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar,17Robert R. Kentish-Barnes N. Boyer A. et al.Ethical dilemmas due to the Covid-19 pandemic.Ann Intensive Care. 2020; 10: 84Crossref PubMed Scopus (173) Google Scholar, 18McQuoid-Mason D.J. COVID-19: may healthcare practitioners ethically and legally refuse to work at hospitals and health establishments where frontline employees are not provided with personal protective equipment?.S Afr J Bioeth Law. 2020; 13: 16-19Google Scholar, 19Dunn M. Sheehan M. Hordern J. et al.‘Your country needs you’: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19.J Med Ethics. 2020; 46: 436-440Crossref PubMed Scopus (42) Google Scholar, 20Emanuel E.J. Persad G. Upshur R. et al.Fair allocation of scarce medical resources in the time of Covid-19.N Engl J Med. 2020; 382: 2049-2055Crossref PubMed Scopus (1932) Google Scholar, 21Jessop Z.M. Dobbs T.D. Ali S.R. et al.Personal protective equipment (PPE) for surgeons during COVID-19 pandemic: a systematic review of availability, usage, and rationing.Br J Surg. 2020; 107: 1262-1280Crossref PubMed Scopus (92) Google Scholar, 22White D.B. Lo B. A framework for rationing ventilators and critical care beds during the COVID-19 pandemic.JAMA. 2020; 323: 1773-1774Crossref PubMed Scopus (528) Google Scholar, 23Lim S. DeBruin D.A. Leider J.P. et al.Developing an ethics framework for allocating remdesivir in the COVID-19 pandemic.Mayo Clin Proc. 2020; 95: 1946-1954Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 24White D.B. Angus D.C. A proposed lottery system to allocate scarce COVID-19 medications: promoting fairness and generating knowledge.JAMA. 2020; 324: 329-330Crossref PubMed Scopus (43) Google Scholar, 25DeJong C. Chen A.H. Lo B. An ethical framework for allocating scarce inpatient medications for COVID-19 in the US.JAMA. 2020; 323: 2367-2368Crossref PubMed Scopus (25) Google Scholar Consequently, specific considerations pertinent to KF care are neglected. In Table 1, we summarize several challenges that may arise as changes in policy and practice affect the ability of kidney health professionals to fulfill their ethical duties toward their patients in providing best practice care. These important issues deserve further elaboration; however, we focus on 3 priority issues of particular ethical complexity: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different KF treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decision making (SDM); and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them. Surges in dialysis demand have been reported during the pandemic as a result of COVID-19–related AKI; there may also be difficulties in meeting regular demand for dialysis as a result of disruption to domestic and international supply chains.5Ramachandran R. Jha V. Adding insult to injury: kidney replacement therapy during COVID-19 in India.Kidney Int. 2020; 98: 238-239Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,6Goldfarb D.S. Benstein J.A. Zhdanova O. et al.Impending shortages of kidney replacement therapy for COVID-19 patients.Clin J Am Soc Nephrol. 2020; 15: 880-882Crossref PubMed Scopus (87) Google Scholar,26Prasad N. Agarwal S.K. Kohli H.S. et al.The adverse effect of COVID pandemic on the care of patients with kidney diseases in India.Kidney Int Rep. 2020; 5: 1545-1550Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,27Sourial M.Y. Sourial M.H. Dalsan R. et al.Urgent peritoneal dialysis in patients with COVID-19 and acute kidney injury: a single-center experience in a time of crisis in the United States.Am J Kidney Dis. 2020; 76: 401-406Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar For example, there may be staff shortages because of illness or isolation measures, people may be unable to travel safely to access dialysis during lockdown periods, medical products such as dialysate fluid may be unavailable because of transport delays or diversion of supplies to meet urgent needs elsewhere, and insufficient supplies of personal protective equipment may limit the ability of clinics to provide full services while meeting infection control standards.26Prasad N. Agarwal S.K. Kohli H.S. et al.The adverse effect of COVID pandemic on the care of patients with kidney diseases in India.Kidney Int Rep. 2020; 5: 1545-1550Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,28Fisher M. Prudhvi K. Brogan M. Golestaneh L. Providing care to patients with AKI and COVID-19 infection: experience of front line nephrologists in New York.Kidney360. 2020; 1: 544-548Crossref Scopus (10) Google Scholar Home dialysis patients may face difficulties in accessing telemedicine, laboratory services, prescriptions, and delivery of dialysis supplies.29Yerram P, Misra M. Home dialysis in the coronavirus disease 2019 era [e-pub ahead of print]. Adv Chronic Kidney Dis. https://doi.org/10.1053/j.ackd.2020.07.001. Accessed August 28, 2020.Google Scholar Although some countries, especially low- and middle-income countries have experience with rationing of publicly funded dialysis,30Luyckx V.A. Smyth B. Harris D.C.H. et al.Dialysis funding, eligibility, procurement, and protocols in low- and middle-income settings: results from the International Society of Nephrology collection survey.Kidney Int Suppl. 2020; 10: e10-e18Abstract Full Text Full Text PDF Scopus (13) Google Scholar,31Flood D. Wilcox K. Ferro A.A. et al.Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals.BMC Nephrol. 2020; : 21PubMed Google Scholar rationing of dialysis in the context of the COVID-19 pandemic may present unfamiliar challenges for many health systems. Notably, people with AKI requiring only temporary dialysis for survival may be unable to access this treatment if systems are overwhelmed. The pandemic may potentially exacerbate the need for rationing in any country and complicate existing ethical dilemmas regarding equity in the allocation of available resources. Some dialysis centers may be able to provide dialysis to only some of those in need, leading some patients to die who would otherwise survive. Other centers may need to compromise on the quality of care provided, for example, by reducing dialysis frequency or duration or by using modalities that are not the preferred or standard treatment for particular patients. Burgner et al. have outlined measures that may increase efficiency in managing dialysis resources and enable more people to receive treatment or survive without dialysis during periods of peak demand.32Burgner A. Ikizler T.A. Dwyer J.P. COVID-19 and the inpatient dialysis unit: managing resources during contingency planning pre-crisis.Clin J Am Soc Nephrol. 2020; 15: 720-722Crossref PubMed Scopus (73) Google Scholar Nevertheless, rationing of resources may be required for a period of weeks, and on a recurrent basis, necessitating long-term planning for equitable and efficient resource allocation. When there are insufficient resources to meet all needs, and those resources are necessary to preserve life, several ethical principles and values are commonly used to guide the allocation of resources so as to avoid or minimize unfair inequalities (inequities)33Persad G. Wertheimer A. Emanuel E.J. Principles for allocation of scarce medical interventions.Lancet. 2009; 373: 423-431Abstract Full Text Full Text PDF PubMed Scopus (603) Google Scholar (see Table 2). In some situations several of these principles and values, taken in isolation, may produce the same conclusion. In practice, they are applied in variable combinations, informed by clinical evidence regarding the likely outcomes of particular allocation frameworks in specific populations, and, ideally, the values and preferences of those populations.Table 2Principles and values guiding resource allocation decision-making in the context of KF care, with examples of their limitationsaThese highlight the need for use of allocation frameworks that engage with a range of considerations pertinent to distributive justice.Avoiding futility: ensuring resources are used only where they will provide a benefit.Maximizing utility: allocating resources to produce the greatest benefits overall for a given population.▪Futility estimates may determine whether to offer dialysis to patients with COVID-19 who are admitted to an ICU given the high rate of mortality in patients with COVID-19 on ventilators and whether to admit patients with existing KF to an ICU if they are COVID-19 positive given their low survival rates.▪Futility must be defined with respect to specific goals and often involves qualitative judgments that may be prone to bias. Decision aids should be used to promote objectivity when evaluating futility.▪Utility—or benefits—is often defined by the number of lives or (quality-adjusted) life-years saved by an intervention; thus, allocation decisions may be informed by estimates of patient survival if they receive a share of resources.▪If applied in isolation, this principle tends to disadvantage those with existing ill health and comorbidities who have poorer chances of longer-term survival (such as many patients with KF), thus potentially reinforcing existing inequities.Reciprocity and solidarity: helping those who are necessary for the provision of care and/or who contribute to the common good.“Fair innings”: focus on allowing all people to live a “normal” life span.▪Health care workers and others who contribute to efforts to provide care for patients with COVID-19, and/or more widespread efforts to support societal well-being during the pandemic, may be prioritized in the allocation of scarce resources in recognition of their contributions and because protecting these workers is beneficial for all. Reciprocity may also encourage prioritization of care for people who have previously contributed to society in other ways.▪Promoting reciprocity and solidarity is often difficult when there are insufficient resources, for example, of PPE. Prioritization of health care worker safety, for example, may be in tension with professional obligations to care for patients, necessitating systemic interventions to ensure that workers are not forced to choose between their own safety and patient well-being.▪Often considered in the context of utilitarian analyses, the “fair innings” approach encourages prioritization of lifesaving treatment for younger patients over those who have already enjoyed a normal, or close to normal, life span.▪If used in isolation, this principle thus systematically discriminates against older persons and effectively devalues the lives of older patients, who are notably more likely to have KF.Prioritarianism: providing first for the worst off.Equality: respecting fundamental right to health.bNotably may be interpreted as promoting equality of health outcomes, opportunities to access care, or shares of resources.▪Often interpreted as prioritizing those most likely to die without treatment, those who have already suffered significant disadvantage (such as long-standing ill health or poor quality of life), and/or those for whom death due to the lack of treatment might be considered a greater harm (e.g., those who have not yet lived a full life—see “fair innings” above).▪Although consideration of prioritarianism may help address existing inequities, if used in isolation it may lead to outcomes that arguably waste vital resources, for example, if those prioritized have a poor prospect of survival even with treatment.▪Underpins justice in resource allocation, and prohibits discrimination on irrelevant grounds such as race, religion, sex, or politics; strategies used to promote equality may include use of lottery (random chance) or a “first come, first served” approach, or the setting of common limits on care for all (e.g., limited trials of dialysis for those with COVID-19–related AKI).•Although respect for an inherent equal right to health is fundamental for any resource allocation framework, it provides limited guidance for the allocation of resources when these are insufficient to meet all needs and when needs are different within or between groups.AKI, acute kidney injury; COVID-19, coronavirus disease 2019; KF, kidney failure; ICU, intensive care unit.a These highlight the need for use of allocation frameworks that engage with a range of considerations pertinent to distributive justice.b Notably may be interpreted as promoting equality of health outcomes, opportunities to access care, or shares of resources. Open table in a new tab AKI, acute kidney injury; COVID-19, coronavirus disease 2019; KF, kidney failure; ICU, intensive care unit. Like mechanical ventilation, dialysis is a life-sustaining treatment. Unlike ventilators, which are rarely used as long-term treatment of chronic end-stage organ failure, dialysis is used in the chronic treatment of >2 million people worldwide.34Liyanage T. Ninomiya T. Jha V. et al.Worldwide access to treatment for end-stage kidney disease: a systematic review.Lancet. 2015; 385: 1975-1982Abstract Full Text Full Text PDF PubMed Scopus (1266) Google Scholar Dialysis machines are also routinel" @default.
• W3089968146 created "2020-10-08" @default.
• W3089968146 creator A5028336036 @default.
• W3089968146 creator A5036931186 @default.
• W3089968146 creator A5068998560 @default.
• W3089968146 creator A5074760833 @default.
• W3089968146 creator A5088349178 @default.
• W3089968146 date "2020-12-01" @default.
• W3089968146 modified "2023-10-16" @default.
• W3089968146 title "Ethics of kidney care in the era of COVID-19" @default.
• W3089968146 cites W1976576973 @default.
• W3089968146 cites W2009377299 @default.
• W3089968146 cites W2133169646 @default.
• W3089968146 cites W2133393736 @default.
• W3089968146 cites W2151559052 @default.
• W3089968146 cites W2734687556 @default.
• W3089968146 cites W2945119237 @default.
• W3089968146 cites W2947445753 @default.
• W3089968146 cites W2994680700 @default.
• W3089968146 cites W3007007150 @default.
• W3089968146 cites W3008979800 @default.
• W3089968146 cites W3009647628 @default.
• W3089968146 cites W3010839841 @default.
• W3089968146 cites W3011562665 @default.
• W3089968146 cites W3012562222 @default.
• W3089968146 cites W3012581356 @default.
• W3089968146 cites W3012690896 @default.
• W3089968146 cites W3012875344 @default.
• W3089968146 cites W3013302817 @default.
• W3089968146 cites W3013577603 @default.
• W3089968146 cites W3013598589 @default.
• W3089968146 cites W3013680672 @default.
• W3089968146 cites W3014504912 @default.
• W3089968146 cites W3015121586 @default.
• W3089968146 cites W3015153650 @default.
• W3089968146 cites W3015434455 @default.
• W3089968146 cites W3015741093 @default.
• W3089968146 cites W3015820665 @default.
• W3089968146 cites W3017086311 @default.
• W3089968146 cites W3017800312 @default.
• W3089968146 cites W3018431282 @default.
• W3089968146 cites W3018511665 @default.
• W3089968146 cites W3018786279 @default.
• W3089968146 cites W3019682307 @default.
• W3089968146 cites W3020444806 @default.
• W3089968146 cites W3020620529 @default.
• W3089968146 cites W3020784542 @default.
• W3089968146 cites W3021706967 @default.
• W3089968146 cites W3022277071 @default.
• W3089968146 cites W3023125385 @default.
• W3089968146 cites W3023700563 @default.
• W3089968146 cites W3023783681 @default.
• W3089968146 cites W3024070984 @default.
• W3089968146 cites W3024644089 @default.
• W3089968146 cites W3024784707 @default.
• W3089968146 cites W3033265709 @default.
• W3089968146 cites W3034295378 @default.
• W3089968146 cites W3034725311 @default.
• W3089968146 cites W3035060467 @default.
• W3089968146 cites W3035376916 @default.
• W3089968146 cites W3036013099 @default.
• W3089968146 cites W3036691156 @default.
• W3089968146 cites W3036857762 @default.
• W3089968146 cites W3037808928 @default.
• W3089968146 cites W3039959689 @default.
• W3089968146 cites W3040549122 @default.
• W3089968146 cites W3041297603 @default.
• W3089968146 cites W3042422579 @default.
• W3089968146 cites W3043466521 @default.
• W3089968146 cites W3048702451 @default.
• W3089968146 doi "https://doi.org/10.1016/j.kint.2020.09.014" @default.
• W3089968146 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7539938" @default.
• W3089968146 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/33038425" @default.
• W3089968146 hasPublicationYear "2020" @default.
• W3089968146 type Work @default.
• W3089968146 sameAs 3089968146 @default.
• W3089968146 citedByCount "16" @default.
• W3089968146 countsByYear W30899681462020 @default.
• W3089968146 countsByYear W30899681462021 @default.
• W3089968146 countsByYear W30899681462022 @default.
• W3089968146 countsByYear W30899681462023 @default.
• W3089968146 crossrefType "journal-article" @default.
• W3089968146 hasAuthorship W3089968146A5028336036 @default.
• W3089968146 hasAuthorship W3089968146A5036931186 @default.
• W3089968146 hasAuthorship W3089968146A5068998560 @default.
• W3089968146 hasAuthorship W3089968146A5074760833 @default.
• W3089968146 hasAuthorship W3089968146A5088349178 @default.
• W3089968146 hasBestOaLocation W30899681461 @default.
• W3089968146 hasConcept C116675565 @default.
• W3089968146 hasConcept C126322002 @default.
• W3089968146 hasConcept C159047783 @default.
• W3089968146 hasConcept C177713679 @default.
• W3089968146 hasConcept C2779134260 @default.
• W3089968146 hasConcept C2780091579 @default.
• W3089968146 hasConcept C2909376813 @default.
• W3089968146 hasConcept C3006700255 @default.
• W3089968146 hasConcept C3007834351 @default.
• W3089968146 hasConcept C3008058167 @default.

• next