Coronavirus (Covid-19) and kidney disease: what do you need to know?

Last week, the New York Times reported on the death of Jamal Uddin, a 68-year-old Brooklyn resident who died of kidney failure while in the hospital undergoing treatment for coronavirus. Uddin’s family said they pleaded for days with doctors at NYU Langone-Brooklyn, where he was in the emergency room, to put him on dialysis as his kidneys failed. But doctors were facing a shortage of dialysis machines, the family said, and waited to treat Uddin until it was too late. 

Uddin’s story signals a potential shortage of dialysis machines, yet another worrisome fact in the fight against coronavirus. Here’s what you need to know.

How does Covid-19 affect the kidneys?

Like a lot of the impacts of coronavirus, the science still isn’t totally clear why coronavirus patients need dialysis. Doctors across the country, however, have noticed that coronavirus attacks the kidneys: the New York Times estimates up to 40 percent of Covid-19 patients in NYC ICUs needed dialysis.

“Right now, dialysis is the key thing that’s needed. I don’t know why they call it Covid pneumonia. They could just as easily call it renal (kidney) failure with pneumonia.” Sam Parnia, a critical care specialist at New York University Langone Medical Center, told CNN

“Nothing like this has ever been seen in terms of the number of people needing kidney replacement therapy,” Dr. David S. Goldfarb, chief of nephrology at the New York campus of the New York Harbor VA Health Care System, told the New York Times.

One 31-year-old man described how the virus had ravaged his kidneys on Reddit’s kidney disease forum: 

The last 8 weeks of my life have been total hell. I never spent any time in the ICU so I would be classified as a “mild case of coronavirus.”

I think it’s important to give background on myself. Before the virus I was very active – I lead fitness classes, ran 20km+ per week, was out on my road bike a couple times per week and did HIIT workouts. I also didn’t smoke or drink and my wife and I eat very healthy. The exception being that sodium intake is a bit higher due to the amount of Asian food we eat:).

8 weeks ago I started getting a dry cough and mild chest pain. This developed into more serious chest pain to the point where I was gasping for air and it felt like my chest would burst. I’ll save the details as they can be seen in my post history. To answer questions, yes I had a PCR test that was positive and an antibody test last week that was positive. I felt better about 4 weeks ago but after very minor exercise the virus completely knocked me out again.

The doctors at the time took my bloodwork and were concerned about my GFR reading (66 around 6 weeks ago) – they told me to monitor it. Doctors took my bloodwork again last week and creatine levels are the same (1.5) and GFR dropped to 55. My urologist referred me to a kidney specialist as a result, but they are only taking “non urgent patients in a month due to coronavirus”.

[Note: GFR stands for glomerular filtration rate, a measurement used to gauge how well the kidneys are working. A normal GFR for healthy adults is 90 or above; if the GFR stays below 60 for three months, that indicates kidney disease.]

I cannot exercise right now – physically I just can’t.

This is probably a dumb question, but I cannot find a satisfactory answer online. If I was healthy before and now have stage 3 kidney damage, can it be reversed? For anyone that has stage 3 or stage 2 kidney damage are you able to exercise with moderate to high stress? Exercise is a defining part of me and I wouldn’t know what to do if I couldn’t exercise…I would do anything to get back on my road bike right now. Any insight is really appreciated.

How is that affecting hospitals and medical systems?

Doctors in New York City sounded the alarm in mid-April that Covid-19 patients in emergency rooms were increasingly using dialysis resources, making machines scarce, with some turning directly to Twitter to plea for supplies.  “We’re splitting [dialysis machines] up, so that you’ll have two patients getting dialyzed for 12 hours each, instead of around the clock,” one doctor at a New York City hospital told NPR.

It’s not just machines that are needed. Other supplies needed for dialysis – including dialysate solution, a mixture of water, electrolytes and salt that helps the machine extract toxins from the blood – are reportedly in short supply as well, doctors and pharmacists have said on social media. Specialized dialysis nurses are also in high demand. And doctors told CNN that blood clots in Covid patients are clogging dialysis filters, likely as a result of cytokine storms – a series of intense immune system reactions to the virus that can turn against the patient’s own body – which increases the need for those special filters.

Some hospitals and device manufacturers are trying to stem the shortage. A Cleveland Clinic nephrologist posted a tutorial online with instructions on how hospitals can make their own dialysate solution. Fresenius, one of the country’s leading dialysis providers, said in April it would help create a loaner pool of machines and dialysis supplies for hospitals.

What about patients who need regular dialysis?

Dialysis machines used in the ICU are different from  the ones chronic dialysis patients use in dialysis centers or in their homes, and there have been no signs that the hospital shortage is affecting non-ICU dialysis. But the coronavirus crisis is also posing challenges for patients outside of the ICU as well. 

On Reddit, dialysis patients and caregivers describe agonizing decisions about maintaining safety while getting treatment during the pandemic. Workers including dietitians and people making home dialysis deliveries report feeling unsafe, while relatives stress over whether or not they should take aging and infirm people into hospitals to begin dialysis during a pandemic. 

The New York Times reported in April that one of the first patients in the United States to die of the coronavirus was a patient at a dialysis center in Washington, and that the country’s hundreds of thousands of dialysis patients are particularly susceptible to infection. While DaVita and Fresenius, the country’s largest dialysis providers, say they are taking steps to keep patients and workers safe, critics say the details are lacking. Anonymous employees told the Times that they feel unsafe at work, while “six out of 10 [dialysis] facilities undergoing routine inspections last year were cited for deficiencies involving infection control.”

“When it comes to responding to Covid-19, the response by large dialysis organizations has been inadequate, leaving some of the most vulnerable exposed to Covid-19, which is especially serious in people with end-stage renal disease,” Dave Regan, president of the Service Employees International Union-United Healthcare Workers West, told the Times.