By Virginia K. Smith
New York hospital systems that have recently found themselves scrambling to get adequate supplies of ventilators for COVID-19 patients are now facing another urgent shortage, this time of equipment and staff required to treat patients suffering from acute kidney failure.
“I don’t think it’s widely known [in the public] that beyond the problem of respiratory failure requiring placement on a ventilator, close to a third of those patients who end up on a ventilator end up needing dialysis,” said Dr. Donald Landry, chairman of the Department of Medicine at Columbia University. “That turns out to be a rather gigantic dialysis need. So it’s placing a strain on resources.”
“We were [recently] over 200% of our typical operating volume” for dialysis patients, said Mount Sinai Hospital clinical director Joji Tokita, who oversees dialysis in the New York medical center. “It’s a huge statement that we were even able to accommodate that,” Tokita said. “As much dialysis as we would like to give under normal circumstances, it’s not possible. We can’t do that. I don’t think anyone can.”
Last week, Dr. Jai Radhakrishnan, a Columbia University professor of medicine, tweeted out an urgent plea for volunteer dialysis nurses and Continues Renal Replacement Therapy dialysis machines, citing “Dire straits in NYC!!”
This means that while New York officials and hospitals have mobilized to address the shortage of ventilators needed to treat patients with coronavirus, facilities throughout the state may not be properly equipped to deal with kidney problems and renal failure, a critical component of treatment for many of the most severely afflicted patients.
In his news conference on Thursday morning, when asked about the concern over dialysis equipment, Gov. Andrew Cuomo said, “If any hospital has a shortage of anything on a daily basis, they let us know and we’ve been able to find that equipment for them, so that nobody has an actual shortfall.”
Treating kidney failure alongside COVID-19
Patients seriously ill with COVID-19 run a relatively high risk of developing kidney failure, part of a larger pattern of organ failure as the disease advances and deprives the body of oxygen.
“We have a large number of patients who have pretty advanced [COVID-19-related] kidney injury, and multi-organ failure,” Tokita said. “Patients come in with shortness of breath, become acutely hypoxic, and other organs start to fail. And a high number of patients, if they’re that sick, require some form of kidney replacement or dialysis.”
The level of treatment required for renal failure can quickly add an additional strain to hospital resources. “In order to do dialysis, you have to put a line in the patient, and put them on a machine,” Tokita said. “And that has to be done by a nurse that’s at the bedside for the duration of the treatment for safety reasons. That’s a bottleneck right there.”
And even as the number of coronavirus patients needing ventilators eases up, there could still be an increase in patients requiring dialysis.
“A lot of patients develop that need [for dialysis] a week or two into hospitalization,” said Dr. David Charytan, division director of Nephrology at NYU Langone Health.
“I think the number of patients and the need for ventilators will go down more quickly than the need for dialysis. And the need for dialysis may continue to grow for a little while.”
The upside is that by all indications, no patients in need of dialysis treatment in New York hospitals have been unable to receive it. “Everyone has gotten what they need and met the needs of their patients,” Landry said. “And yet we think that this is something that the powers that be should be aware of because we’re not out of it yet.”