Coronavirus Update: Doctors See Unexpected Rise In Patients With Failing Kidneys

Since early March, hospital executives and government officials have been warning about a looming shortage of mechanical ventilators as the coronavirus pandemic reaches U.S. shores. Today, doctors are warning about an unforeseen shortage of supplies, staff, and machines needed for emergency dialysis. This came about with the unanticipated increase in patients with failing kidneys.

Recently, New York doctors in intensive care units learned that coronavirus has been shutting down the kidneys of patients. This presented another challenge for doctors who must now transport a limited supply of dialysis machines from one patient to the next. According to doctors, they fear they may not be able to have these machines ready for everyone to save their lives.

A Vital Role

Doctors are unsure if the kidneys are among the major targets of the coronavirus or just an organ that fails as the ravaged body of the patient surrenders. Dialysis takes over the role of a kidney, such as clearing the blood of toxins, removing excess fluids, balancing vital components including electrolytes, and keeping blood pressure in check. Using these machines may be a temporary measure as the kidneys recover, or it may be a long-term measure if kidneys fail to recover.

Another unknown aspect is whether damage to the kidney caused by coronavirus is permanent. According to Dr. David S. Goldfarb, New York City nephrologists are almost at their wits end in ensuring that everyone with a failing kidney gets treated. Dr. Goldfarb said, “We don’t want people to die of inadequate dialysis.” Dr. Goldfarb is the chief of nephrology of the New York Harbor VA Health Care System at its New York campus. He added that nothing like this has ever happened in terms of the number of patients requiring kidney replacement therapy.

No Dialysis Machines

The growing demand, not only in New York but nationwide, for kidney treatments is straining the most advanced care units in hospitals located in developing hot spots. These include New Orleans, Chicago, Detroit, and Boston. According to Dr. Alan Kliger, kidney specialists estimate that around 20% to 40% of I.C.U. patients with COVID-19 infection also suffer from kidney failure and require emergency dialysis. Dr. Kliger is a nephrologist at Yale University School of Medicine and the co-chairman of a coronavirus response team for the American Society of Nephrology. Dr. Kliger said that the usual supplies of the hospitals are running out rapidly.

A doctor in New York City who declined to be identified as he was not authorized to make public pronouncements, recalled agonizing exchanges with other doctors last week. “You’re yelling at them. You’re telling them you don’t have a dialysis machine to give them. You hear the intensity and the desperation in the other person’s voice,” said the N.Y.C. doctor. He also said his job is quickly transforming like hell.

Surprised By Scarcity Of Devices

As the virus rapidly spread in many big cities across the United States, mayors have clamored for more ventilators. There was no talk, however, about dialysis machines. Doctors are even surprised at the scarcity of these devices. The shortage is not limited to the devices itself but also on its attendant fluids and supplies needed in a dialysis regimen, as well as trained nurses to provide treatment.

The Federal Emergency Management Agency has called the shortage of dialysis supplies and equipment as “unprecedented.” They said they are currently working with hospitals and manufacturers to identify supply sources both within the U.S. and overseas. According to Dr. David Charytan, N.Y.U. Langone Medical Center’s chief of nephrology, everybody has regarded this as a respiratory illness. “I don’t think this has been on people’s radar screen,” Dr. Charytan said.