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COVID-19-caused Kidney Injuries Heighten Demand for Dialysis

Published: 05/17/2020 on McKnights

A large number of coronavirus patients are suffering kidney damage, contributing to a growing need for onsite dialysis in eldercare facilities, according to experts.

An estimated 15% of patients hospitalized for coronavirus develop acute kidney injury, according to the National Kidney Foundation. And the odds increase if a patient ends up in intensive care, with numbers rising to 20% or more. Potentially half of these patients may require dialysis, said Joseph Vassalotti, M.D., the foundation’s chief medical officer. 

Data collection is ongoing, as most coronavirus patients with kidney problems are still hospitalized. As a result, the number of recovered patients who experience complete kidney failure, partial recovery or complete recovery remain unknown, Vassalotti said. But in one preprinted study by Columbia University researchers, 75% of ICU patients at a New York hospital developed acute kidney injury and 31% required dialysis.

“A whole group of people with no previous history of kidney disease now face an acute kidney injury, which brings with it an increased risk for developing chronic kidney disease,” the NKF said in a statement. “We believe this may be a looming healthcare crisis that will put a greater strain on hospitals, dialysis clinics and patients.”

Dialysis needs growing

Meanwhile, the need for hemodialysis care is growing as these patients return to eldercare facilities, according to one provider. Dialyze Direct said it’s seen an approximate 114% growth in demand for onsite home hemodialysis care within skilled nursing facilities since the start of the pandemic. 

“I think it is clear that this is largely due to the havoc COVID-19 is causing to kidneys,” said Jonathan Paull, chief compliance officer.

The first spike in dialysis needs happened when some nursing homes — in collaboration with hospitals and health officials — opted to move residents to facilities that offered onsite home hemodialysis. The idea was to lessen the risk of additional viral exposure brought by travel to outpatient sites, said Paull. A more recent uptick in demand is due to the increased needs of COVID-19 survivors.

“[The] growth in demand that has occurred in just the past few months within the dialysis industry at large is equivalent to years of census growth in a non-COVID-19 pandemic world,” Paull said. 

Kidney injuries tied to COVID-19 tend to be severe, with rapid increases in blood urea nitrogen and creatinine, Vassalotti said. The two leading risk factors are pre-existing kidney problems and the severity of COVID-19. Causes are varied and are thought to include extreme immune system response and inflammation, increased blood clotting, and direct kidney infection, he explained.

Some experts believe chronic kidney disease will become a lasting legacy of the coronavirus pandemic. But few Americans (17%) are currently aware that the diseases are linked, according to a Harris poll sponsored by the NKF.

Once kidneys fail, dialysis or a transplant is needed to survive.