An overlooked crisis: a dire need for kidney dialysis

For weeks, U.S. government officials and hospital executives have warned of a looming shortage of ventilators as the coronavirus pandemic descended.

But now doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in COVID-19 patients with kidney failure that is leading to shortages of machines, supplies and staffers required for emergency dialysis.

In recent weeks, doctors on the front lines in intensive care units in New York and other hard-hit cities have learned that the coronavirus isn’t only a respiratory disease that has led to a crushing demand for ventilators.

The disease also is shutting down some patients’ kidneys, posing yet another series of lifeor-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 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 in emerging hot spots like Boston, Chicago, New Orleans and Detroit.

Kidney specialists estimate that 20% to 40% of ICU 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.

As the coronavirus spread rapidly in New York and other cities, governors and mayors clamored for thousands more ventilators. But doctors have been surprised by the scarcity of dialysis machines and supplies, especially specialized equipment for continuous dialysis. That treatment often is used to replace the work of injured kidneys in critically ill patients.

The shortages involved not only the machines but also fluids and other supplies needed for the dialysis regimen. Having enough trained nurses to provide the treatment also has been a bottleneck.

Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand. The fluids needed to run the dialysis machines are not on the Food and Drug Administration’s watch list of potential drug shortages.