COVID-19 and the dialysis supply chain

The COVID-19 pandemic has hit the kidney community particularly hard. Not only are people with kidney disease—especially dialysis and post-transplant patients—at higher risk for serious cases of COVID-19, but the kidneys are among the organs most affected by the toll this disease takes on a person’s body. Hospitals have reported shortages of dialysis machines, dialysate and other supplies due to the increasing numbers of people who now need dialysis because of COVID-19.

We recently spoke to Dr. Sagar Nigwekar, a Massachusetts nephrologist and former AKF Clinical Scientist in Nephrology fellow, about the situation at his hospital and how they are managing dialysis supplies for both existing dialysis patients who became infected with COVID-19 and COVID-19 patients who need emergency dialysis.

How does COVID-19 affect the kidneys?

Your kidneys are vital organs that remove toxins from your blood and they depend on normal blood flow in order to work properly. Although COVID-19 has been causing acute kidney injuries (AKI) and kidney failure in about 25% of patients, it’s not exactly known why. We think COVID-19 may be attacking the kidneys because it causes inflammation in some patients’ bodies, which may decrease blood flow to the kidneys. Importantly, patients with COVID-19 who develop kidney problems are at a much higher risk for serious complications, including death, than those who do not experience kidney problems.

Why do some COVID-19 patients need dialysis?

In some COVID-19 patients, kidney failure is severe and may cause complications like fluid and toxin build-up in the blood, which healthy kidneys would normally remove. For these patients, like all other kidney failure patients, dialysis is a lifesaving treatment. There are also COVID-19 patients who were already on dialysis before getting sick with this new disease and those patients need to continue their regular dialysis treatments.

If a dialysis patient needs to be hospitalized because they have become infected with COVID-19, how does your hospital make sure they get the care they need to survive?

Dialysis patients who are in our hospital for COVID-19 will receive their dialysis at the hospital. Some of our COVID-19 dialysis patients have been grouped into treatments together to minimize the spread of the disease to other dialysis patients. We’re closely monitoring all dialysis patients and providing everyone with masks to wear at all times during dialysis. Our priority is to provide everyone with the care they need and keep all patients safe at the same time.

How has your hospital handled the increased number of people needing dialysis?

It has been extremely challenging at times. The hospital I work at has reached out to other hospitals in our area to understand the region’s overall availability of supplies. We review all of our supplies twice a day. We’ve placed orders for additional supplies with multiple vendors. On some occasions, we adjusted dialysis prescriptions in such a way that we can dialyze more than one patient with the same amount of supplies, but that means patients may not be receiving the highest quality of care we strive for each day. Decisions like this add extra stress to patients and their caregivers, as well as to the doctors and nurses.

What can hospitals do to make sure they have enough dialysis machines and supplies for COVID-19 patients who need them?

We’ve developed a close network of area hospitals so supplies can be shared, if needed. Hospitals in other areas can do that as well. It’s also important to look into best practices for cleaning and servicing dialysis machines more efficiently to allow you to spend more time treating patients.

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About the Author(s)

Sagar Nigwekar, M.D., MMSc and Reni Bello

Sagar Nigwekar, M.D., MMSc, is an assistant physician (nephrology) at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School. He was an AKF Clinical Scientist in Nephrology fellow in 2012-13.

Reni Bello is the associate director of public education at the American Kidney Fund.

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