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To the Editor: Dialysis care is among the many health care activities to be severely affected by coronavirus disease 2019 (COVID-19). Further, health care facilities in limited-resource settings are challenged with unique problems warranting distinct strategies to combat this crisis. Our administrator was summoned to set up a state-of-the art facility for managing infected patients in a jiffy. A newly constructed block that otherwise housed 3 departments was vacated to make way for a 250-bed COVID-care facility in March. Considering the renal complications of COVID-19 and susceptibility of the end-stage renal disease population to COVID-19, a decision to provide point-of-care hemodialysis (HD) in the COVID-care facility was taken, both intermittent and sustained low-efficiency dialysis for stable and critically ill patients, respectively. As there was no time for setting up a water treatment plant, we used the feed water pipes of the water sinks to connect to the inlet pipe of a locally made portable reverse-osmosis device having sand, carbon, micron cartridge filter, and ultraviolet light in addition to reverse-osmosis module. With this, we could initiate dialytic therapy in a couple of hours. Securing the water inlet source was not the end of the problem, as we encountered unexpected hurdles hampering optimal dialysis delivery in this makeshift facility.

Challenges in Setting Up Point-of-Care Hemodialysis in a COVID-19 Care Facility: Lessons From a Limited-Resource Setting