Table 1.

Summary of opinion-based local management guides for patients with kidney diseases during the pandemic

DomainGuidance
New patient referralsVirtual pre-evaluation through telehealth
Advance assessment
CKDHome BP and weight diaries
Small group webinars for CKD education, nutrition, and option teaching
Office-based 1:1 option counseling combined with follow-up telehealth visit
Mail-order pharmacy
Home ESA injection
Office-based ESA injections: increase dose of ESA and decrease frequency
Space out monthly laboratory tests to every 6 wk and quarterly laboratory tests to every 4 mo
Increased frequency of telehealth check-ins in between laboratory assessments
ESKDMonthly telehealth visit for home modalities
Preserve in-center dialysis rounds
Strong collaboration with adoption of testing and cohorting strategies according to CDC and dialysis vendor guidelines
Kidney transplantPrioritize pretransplant testing for patients with approved living donors and higher chance to receive a deceased donor offer (longer waiting times and high HLA cPRA)
Reduce testing frequency, especially after second year post-transplantation
Maximize virtual care with preference of video over telephone visits
Hold protocol biopsies during peak of pandemic
Glomerular diseasesMinimize IS to the extent allowable without risking relapse
Leverage serology-based diagnosis instead of tissue biopsy whenever possible (e.g., PLA2R titers in nephrotic syndrome, ANCA titers in RPGN)
Consider using reduced-dose steroids regimens for indications where reduced-dose steroid has shown to be equally effective (e.g., ANCA GN, lupus nephritis)
  • ESA, erythropoiesis-stimulating agent; CDC, Centers for Disease Control and Prevention; cPRA, calculated panel reactive antibody; IS, immunosuppression; PLA2R, phospholipase A2 receptor; RPGN, rapid progressive GN.