COVID-19 Causing Kidney Damage, Dialysis Challenges For Patients

In a COVID-19 or any patient, the consequences of an acute kidney injury can be severe. For a critically ill patient in the intensive care unit who develops one, for instance, the risk of death is somewhere between 40 to 70 percent, says Paul Palevsky, M.D., president-elect of the National Kidney Foundation and professor of medicine at the University of Pittsburgh School of Medicine.

"We don't really know the mortality rate of patients with a COVID-19 infection and acute kidney failure. Some reports have been as high of a mortality rate of 90 percent. It's too early to know,” he says.

As for how many patients will develop kidney injury from COVID-19? Initial reports from China, where the COVID-19 virus first began, suggested a fairly low rate, of around 5 percent of total cases, says Palevsky. However, new data from Italy and New York City suggest a much higher rate of kidney injury from the virus. “It's possibly as high as 25 to 40 percent among the sickest hospitalized patients in the intensive care unit. The sicker the patient, the more severe the kidney involvement,” he says.

In the most extreme cases, patients who go into acute renal failure lose their ability to remove waste and balance fluids in the body, and need dialysis or mechanical purification of their blood.

Doctors know how to treat the problem, but circumstances are getting in the way.

Dialysis shortages in some areas

"I think everyone has read in the news about the fear of not having enough ventilators and needing to triage patients as to who gets a ventilator and who would not. In fact, the same problem is happening with our ability to provide dialysis in areas that have seen a surge of patients needing them, such as in New York City,” says Palevsky.

These shortages have presented major challenges to patient care, he notes. There are more patients than machines for dialysis, as well as shortages of materials needed for performing dialysis, including disposable tubing and fluids. Usually one machine is used to treat patients with acute renal failure continuously for 24 hours a day for as long as a patient needs that therapy.

Some hospitals experiencing equipment shortages are now treating patients on a 24-hour-on, 24-hour-off basis, so they are able to treat twice as many patients with the same number of machines. Hospitals in areas that are past a COVID-19 surge also are trading dialysis equipment with those in the thick of the outbreak.

While dialysis shortages present an urgent problem in certain areas, there is hope on the horizon for reducing the risk of organ damage by COVID-19, says Hamid Rabb, M.D., professor of medicine and medical director of kidney transplantation at Johns Hopkins University.

At Johns Hopkins, for instance, “there are many different trials currently underway to decrease the abnormal hyperinflammatory response of COVID-19,” Rabb says. “Some of the initial studies are very promising. I hope that in a few weeks we will have a better idea of how these trials are working."