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While COVID-19 continues to attack patients’ lungs, an unanticipated trend has surfaced: acute kidney injury — and a reported lack of ICU dialysis machines to treat it.
In New York, after officials scoured for ventilators to lend severely ill patients a fighting chance against COVID-19, some hospitals are now experiencing short supply of but high demand for ICU dialysis machines, in particular, which operate around the clock, 24 hours a day.
People with kidney disease and transplant recipients are at higher risk for developing serious complications from COVID-19, but doctors in New York told NPR that they are finding a portion of their severely ill patients are developing rapid decline in kidney function, even in patients "who don't have advanced diabetes or chronic renal conditions."
"We've been worrying about lungs, we've been talking about damage to the lungs, and inflammation and blood clots in the lungs, but we have 6,500 ventilators in New York and it looks like that's been enough so far -- the real issues is what else besides the lungs does this virus infect?" Dr. Marc Siegel, Fox News medical contributor, said.
Doctors who spoke under the condition of anonymity to NPR reported a “rationing” of dialysis care as cases overwhelm the supply of dialysis machines. One ICU physician from Queens, N.Y., for example, reported about 10 machines with more than 30 patients in need of them.
"So it becomes a question of who the resource goes to, and these are very difficult decisions," the doctor, who manages an intensive care unit, said.
Another told NPR that machines are being split between patients to compensate, so rather than receive 24 hours of dialysis each patient is only receiving 12, which "isn't how it's intended to be used."
"About 1/3 of the people who are in the ICU suffering from COVID-19 have significant and severe kidney problems, so there's been a lot of communication around the city about sharing supplies and getting more supplies in place," Siegel said.
But not all hospitals in New York are seeing shortages of these machines.
"We haven't had to ration health care at NYU, at Bellevue or the VA," said Dr. David Goldfarb, a nephrologist at all three hospitals, told NPR.
"We've had discussions about whether rationing was going to occur, under what circumstances it would occur, how that would go, what person or group of people would make those kinds of choices. We've read the documents that exist providing guidance on this topic. But, fortunately, we haven't quite gotten there," he added.
As scientists work to understand how the virus may be affecting the kidneys, Goldfarb noted that it's hard to determine if and a lack of full-time dialysis is affecting – and possibly killing – COVID-19 patients in the ICU.
"Lung failure and kidney failure is a really bad combination — and I'm not even confident that dialysis of any sort will change the mortality of that combination," he told NPR. "But we want to be able to address that kidney failure with all the techniques that we have."