COVID-19’s toll on kidneys puts strain on dialysis supplies

Coronavirus may primarily attack the lungs, but an unexpected complication — kidney failure — has become another major obstacle for doctors in the ICU. It has also created a new and perhaps overlooked medical supply crisis — an acute shortage of dialysis resources.

Video Transcript

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ALAN KLIGER: I've been a kidney doctor since 1975. So I've been in this business a long time. I've never seen anything like this. We knew early on that there was a problem with the kidneys from the infection, but the real surprise was that when the pandemic hit in the United States, we found that between 20% and 40% of patients who were in intensive care units with this infection, the kidneys failed.

SUSANA BEJAR: People have severe renal failure to the point of needing dialysis, and not even just dialysis, but a special kind of dialysis that can only be done in intensive care units because patients are too unstable to tolerate the fluid shift of regular dialysis.

STEVEN FISHBANE: I think that when people hear dialysis, first, I mean, what people usually think of are dialysis centers that are in the community where patients go three times a week, usually, to have their blood cleaned by dialysis machines. This is different. So that would be called chronic kidney disease, or chronic kidney failure. This is acute. So this happens when people are very sick.

ALAN KLIGER: The difference between the two is that in acute kidney injury, often the kidneys do recover function once the infection is gone. For COVID-19, what we're learning is that some patients who survive the illness, their kidney functions can get better, but there are other patients who, even though they survive the infection, still have kidney failure and still require dialysis. So those are people who might be able to leave the hospital, but need to continue with those dialysis treatments.

STEVEN FISHBANE: In patients, say, with COVID or coronavirus, who are sicker, who have low blood pressure and difficult to manage, regular dialysis doesn't work. So then we get to this other type of dialysis-- it's CRRT, Continuous Renal Replacement Therapy. But the major difference is really just that they're slowed down so that, rather treating in three or four hours, we can treat much slower to be able to remove fluids and toxins in a way that allows the blood pressure to remain stable.

ALAN KLIGER: If you look at the large urban areas that have been hotbeds of COVID-19, like New York City, or Chicago, or Detroit, as examples, in each of those places, the amount of CRRT or dialysis that's been needed has far exceeded anything we've done before, has strained the system. The CRRT machines require fluid to be used, liters and liters of fluid to help clean the blood. Many hospitals at the height of the pandemic were starting to run short of those fluids.

STEVEN FISHBANE: The bigger issue for us at that point was nursing, that for the ICU, the Intensive Care Units nurses who were now taking care of four patients per nurse. That's really spreading them and causing tremendous, tremendous stress on the nurses running CRRT treatment. You know, there definitely was a point there when this locally epidemic was at its highest peak. We're running on fumes. I mean, we just barely had enough disposables, fluids, filters to be able to get by, but I think we had done enough preparation. So we were never in a position of having to deny kidney care to any patient because of a lack of supplies.

SUSANA BEJAR: Overall, the volume of patients in the emergency department is down, but what's taking a much longer time to go down is the population in the intensive care unit. So that sickest population, that's still pretty stable, and those are the people that need the incubation and the special kind of dialysis.

ALAN KLIGER: New York was the huge demand last week and this week. And in three weeks from now it could be many other places, or it could be in New York again. Those are all the things that FEMA, and the government, and the suppliers, and the hospitals, and our organization are working together to try to make sure we can engineer. We are more prepared than we were two weeks ago, but honestly, we're continuing to learn the lessons and try to share those messages so that Phoenix, Arizona, for example, when faced with the same issues, will be perhaps better prepared from the lessons we've learned in the early hotspots.