People Hospitalized with COVID-19 Now Facing the Risk of Kidney Damage2020-04-21
- Doctors in New York City say people hospitalized with severe cases of COVID-19 are experiencing kidney damage.
- The doctors say this phenomenon is putting a strain on dialysis machines and other equipment used to treat kidney injury.
- They say a national effort is needed to help New York City with this emerging health issue as well as prepare smaller hospitals across the country.
At some hospitals in New York City, the rate of kidney damage among people with COVID-19 is putting an additional strain on medical professionals.
That’s how one physician characterized the situation when he tweeted about a lack of dialysis equipment and called for donations of supplies and volunteer dialysis nurses.
Hospitals in New York City are being inundated with patients with COVID-19, many of whom are showing signs of serious kidney damage.
However, medical professionals tell Healthline there’s not enough equipment available to treat these patients.
“It’s an extremely serious problem. It’s putting many people’s lives at risk all over the New York region. It is, unfortunately, a common complication, especially for the hospitalized patients with COVID, to develop acute kidney injury. I would say close to 50 percent of the (COVID) patients in the ICU setting are developing acute kidney injury,” said Dr. Michael J. Ross, chief of the division of nephrology at Montefiore Medical Center in the Bronx.
Ross added that 20 to 30 percent of people in the ICU are requiring some form of dialysis to stay alive.
Many of the people requiring dialysis reportedly had healthy kidneys before developing COVID-19.
Doctors say this is concerning.
“This is a horrible, relentless, nasty disease in its severe form. If the patient is obese and/or has renal failure, the prognosis is extremely grim,” a physician from NewYork-Presbyterian Hospital tweeted.
“We are forced to share dialysis circuits given the high percentage of renal failure (these people had normal kidneys before!),” the same doctor tweeted.
A report from the front lines
Dr. Shivam Joshi is a nephrologist and primary care physician in New York City.
He says recent reports from China show that a much higher number of people with COVID-19 are experiencing acute kidney injury than was initially suggested.
“It was originally reported that only 0.5 percent affected in China had acute kidney injury, but now that number is 3 to 9 percent of cases or higher. That’s concerning when there’s a virus as infectious as the coronavirus and affecting so many people,” Joshi told Healthline.
He said a lack of resources is compounding an already serious problem for patients with COVID-19 who are experiencing acute kidney injury.
“Supplies for everything are very stretched in hard-hit areas,” Joshi said. “Dialysis machines, equipment, dialysis nurses — all of these things are in short supply. Suppliers and distributors are facing unprecedented demand and are trying to be equitable by rationing their fulfillment. So instead of receiving 100 units, they’re only providing 20 units to each customer.”
Sharing treatment equipment
Dr. Paul M. Palevsky is president-elect of the Kidney Foundation as well as a professor of medicine at the University of Pittsburgh.
Throughout his career, Palevsky says, he has never seen such an inability to treat people due to the high volume of people requiring care.
“It’s something that we’ve never had to deal with to this extent in this country,” he told Healthline. “If you can’t provide dialysis to someone who absolutely needs it, patients can die of kidney failure. That is a frank reality.”
In hospitals where dialysis supplies are stretched, doctors are getting creative to try and care for such a high volume of patients.
“(For) patients in the ICU, we often need to do a slow gentle type of dialysis that might go 24 hours a day, and instead of doing that, what we end up having to do is doing more aggressive, shorter treatments so we can use that same machine on more than one patient per day. We’re doing the best we can with the equipment and supplies we have, but we simply need more,” Ross said.
Palevsky notes that sharing equipment is also causing problems for the preservation of other supplies.
“That’s a safe way to provide treatment, but it’s an extreme that we rarely, if ever, have had to deal with before,” he told Healthline. “The downside to that is that goes through the consumables rapidly. That is creating its own problem, where supplies can’t be replenished as rapidly as they’re needed.”
The risk to people with COVID-19
The kidneys filter out extra blood, toxins, and electrolytes that build up in the blood as we eat and drink, and as our tissues break down.
If the kidneys don’t work, these toxins build up in the blood.
People who are severely ill with COVID-19 are at risk of their kidneys completely shutting down.
When that occurs and is accompanied by significant amounts of tissue damage, toxins build up in the blood, and there are disturbances to electrolyte levels that can make the heart stop.
Dialysis treatment acts as a way to clean the blood of excess toxins, and without it, doctors say people will die.
“A lot of these patients when they’re very sick actually have increased need for kidney function because there’s a lot of tissue breakdown, which releases a lot of toxins into the bloodstream, so they have an even bigger need to have their blood clean,” Ross said.
National effort needed
Dr. Barbara Murphy is chair of the department of medicine at Mt. Sinai Healthcare System in New York and a council member of the American Society of Nephrology.
She says there needs to be a response at the national level to better equip New York City hospitals with resources.
“There needs to be a coordinated effort from outside of New York to be able to bring supplies in to be able to help those institutions and to support them. There was a lot of focus on ventilators; there needs to be with that consideration of the need around dialysis and preparation for that,” Murphy told Healthline.
She said there also needs to be an effort to support smaller hospitals across the country that may not have the same expertise in nephrology.
“What happens when this hits other smaller hospitals or smaller places across the country that don’t have the same breadth of expertise and breadth of experience with regards to nephrology? It’s going to take an even greater burden,” she said.
Ross said that if things continue as they are and hospitals across New York City aren’t better equipped to cope with demand, more deaths will occur.
“It’s extremely stressful as a doctor to try to be saving the lives of people and not have access to the treatment you know you need to save that person’s life,” he said.
“Unfortunately, patients will die for lack of access to these treatments to replace kidney function. For people to die due to kidney failure because of lack of available dialysis is a tragedy, and it’s preventable,” he said.
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