File photo from 26 March of the Mater Hospital PA Wire

Covid-19 impacting patients' kidneys with many ending up needing dialysis

Irish authorities were ahead of the curve and got extra kidney treatment equipment and supplies after the disease outbreak in northern Italy.

COVID-19 IS hitting patient kidneys, not just their lungs.  

Early reports from China hinted that the kidneys were infected by the virus, and since then, hospitals in Italy, London and New York were left scrambling for dialysis
machines when hospital cases spiked.

“It has been clear that the kidney is a target,” said Alan Kliger, a clinical professor of medicine at Yale University, who saw a surge in Covid-19 patients suffering from kidney failure in New York.

Dr Kliger estimates that up to half of patients in intensive care had kidney failure in New York hospitals.

Those patients “actually had acute kidney failure that required renal replacement therapy”, explained Dr Kliger, who is co-chairman of a Covid-19 response team for the American Society of Nephrology.

Dialysis machines take over the role of the kidneys in scrubbing blood of toxins and removing excess fluids.

Early in hospitalisation some patients show kidney damage, which suggests kidneys are infected by the virus early on, said Dr Kliger.

Those most at risk of kidney failure are often the same patients at higher risk of dying from Covid-19, such as those with existing kidney disease, high blood pressure, diabetes and lung disease.   

“Among patients in intensive care units, probably 75% of them are on ventilators, and roughly 40% or so are on dialysis or other renal (kidney) replacement therapies,” said Dr Kliger. 

He adds that the pandemic increased roughly five-fold the need for renal replacement therapy.  

Most medical centres in New York don’t have the ability to flex up five times more kidney therapy than usual.

Several hospitals there, having seen what happened in Italy, had ordered additional equipment, additional filters and additional fluids for dialysis in advance, said Dr Kliger. 

Between 20 and 30% of Irish patients who survive Covid-19 require dialysis after intensive care.

“This was expected, following the Italian experience,” said Mark Murphy, chief executive of the Irish Kidney Association.

He said Irish authorities were ahead of the curve and got extra kidney treatment equipment and supplies after the disease outbreak in northern Italy.

Last year, there were over 2,000 Irish people on dialysis. Eleven acute hospitals host dialysis units. 

“Most dialysis units are running two shifts, morning and afternoon for four hours each, according to Murphy. They could run an evening shift, so there is spare capacity, he said.  

Some kidney units in hospitals are quite small, said Murphy, but flattening the infection curve in Ireland has meant that they did not get overwhelmed.  

In the US, Dr Kliger said medics must figure out what to do today, in the midst of a pandemic, but also look to the future. 

“The 20th-century approach of just-in-time ordering, making sure that you don’t stack your shelves, but have the ability instead to order what you need and have it shipped to you has been a great business model in the 20th century,” said Dr Kliger. 

“Clearly that model fails at a time of a pandemic.”

He advocates a more flexible and global approach for the 21st-century which would see stockpiling of medical equipment.

“It doesn’t have to be stockpiled in every hospital, or every state or even every country. There needs to be global thinking, with reserves that can be sent where they are needed. A pandemic moves in waves, and doesn’t happen at the same moment everywhere,” said Dr Kliger.

Anthony King is a freelance science journalist working in Dublin. You can find him on Twitter @AnthonyJKing

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