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Kidney Patients Should Take Extra Precautions During the Pandemic

Published: 05/08/2020 on Houston Chronicle

By Lindsay Peyton | Excerpted from original version.

Dr. John Foringer is getting a lot of calls from patients with chronic kidney disease.
His patients want to know if they are more likely than others to contract the coronavirus and whether they are susceptible to greater complications.

“We don’t know the answer yet,” said Foringer, chief of medicine at Lyndon B. Johnson Hospital and professor of internal medicine in the Division of Renal Diseases and Hypertension at UTHealth.

There isn’t yet enough data to understand specific risks or complications. But it’s not too soon to recommend that patients with kidney disease take extra precaution. As part of the larger group of patients with chronic medical conditions, they are simply at higher risk.

“I’ve been telling my patients to isolate themselves as much as they can,” Foringer said. “This is definitely a concern for them.”

Kidney patients, including those with transplants who are taking anti-rejection or immunosuppressive medicines, should take extra precautions, according to Dr. Donald Molony, a nephrologist with Memorial Hermann Texas Medical Center and professor of renal diseases and hypertension at UTHealth. He noted that individuals who are already on dialysis cannot be socially isolated if they receive regularly scheduled treatment outside of their home; if dialysis is not continued, it can jeopardize a patient’s health.

“It’s a lifesaving treatment,” Molony said.

“There is a growing acknowledgment that many patients would be best served by doing dialysis at home,” Molony said. “The problem with that is that patients who go home need to be trained. And that’s another barrier.”

Additionally, there’s a new population of individuals diagnosed with COVID-19, who develop acute kidney injury and leave the hospital in need of continued dialysis treatment.
For each group, Molony said, medical teams are taking steps to ensure that needs are met. “All of the providers are working diligently together to make sure that patients are safe,” he said.

Kidney failure and COVID-19

Acute kidney injury related to COVID-19 has been mounting, leading some researchers to question whether the coronavirus specifically targets the kidneys.

“At this stage, it’s too early to tell,” said Dr. David Sheikh-Hamad, professor of medicine-nephrology at Baylor College of Medicine.

Patients with COVID-19 develop what is known as a “cytokine storm,” or an overproduction of cytokines, due to the inflammatory response triggered by the coronavirus, Sheikh-Hamad said. This can affect multiple organs and cause leakage in blood vessels of the lungs, resulting in what is known as acute respiratory distress syndrome (ARDS), which leads to respiratory failure, Sheikh-Hamad explained. Patients with acute respiratory distress syndrome are placed on ventilators.