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An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis
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Ventilators aren't the only machines in intensive care units that are in short supply. Doctors have been confronting an unexpected rise in patients with failing kidneys.
https://www.nytimes.com/2020/04/18/health/kidney-dialysis-coronavirus.html?action=click&module=Spotlight&pgtype=Homepage
The disease is also shutting down some patients' kidneys, posing yet another series of life-and-death calculations for doctors who must ferry a limited supply of specialized dialysis machines from one patient in kidney failure to the next. All the while fearing they may not be able to hook up everyone in time to save them.
It is not yet known whether the kidneys are a major target of the virus, or whether they're just one more organ falling victim as a patient's ravaged body surrenders. Dialysis fills the vital roles the kidneys play, cleaning the blood of toxins, balancing essential components including electrolytes, keeping blood pressure in check and removing excess fluids. It can be a temporary measure while the kidneys recover, or it can be used long-term if they do not. Another unknown is whether the kidney damage caused by the virus is permanent.
"The nephrologists in New York City are going slightly crazy making sure that everyone with kidney failure gets treatment," said Dr. David S. Goldfarb, chief of nephrology at the New York campus of the New York Harbor VA Health Care System. "We don't want people to die of inadequate dialysis."
"Nothing like this has ever been seen in terms of the number of people needing kidney replacement therapy," he said.
Outside of New York, the growing demand nationwide for kidney treatments is fraying the most advanced care units in hospitals at emerging hot spots like Boston, Chicago, New Orleans and Detroit.
Kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis, according to Dr. Alan Kliger, a nephrologist at Yale University School of Medicine who is co-chairman of a Covid-19 response team for the American Society of Nephrology.
The fluids needed to run the dialysis machines are not on the Food and Drug Administration's watch list of potential drug shortages, although the agency said it was closely monitoring the supply. The Federal Emergency Management Agency described the shortage of supplies and equipment as "unprecedented," and said it was working with manufacturers and hospitals to identify additional supplies, both in the United States and overseas.
"Everybody thought about this as a respiratory illness," said Dr. David Charytan, the chief of nephrology at N.Y.U. Langone Medical Center. "I don't think this has been on people's radar screen."
The supplies allocated by manufacturers are insufficient, Dr. Charytan said, adding that the hospital switched to another type of machine when it couldn't get additional equipment it had wanted. "It just doesn't come anywhere close to meeting the need," he said.
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