Hospitals need dialysis equipment as thousands of coronavirus patients develop kidney problems. | Rich Pedroncelli/AP Photo
Hospitals in New York City are running out of dialysis fluids as thousands of coronavirus patients develop kidney failure, an unexpected development that could presage the next critical supply shortage nationwide.
Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks, a development that many providers did not see coming. FEMA held a call Monday with FDA and CMS to discuss the possibility of issuing emergency use authorizations to import more dialysis fluids, according to a document obtained by POLITICO.
But shortages are already testing hospitals in New York, where more than 202,000 people have become infected and almost 11,000 have died. The same day that federal regulators met, major New York hospital systems convened to discuss the emerging dialysis crisis. Some are struggling with dire shortfalls of dialysis fluids and trained nursing staff, and have reached out directly to manufacturers for help, according to two people on the call.
Together, the hospitals — including NYC Health + Hospitals, Northwell Health, NYU Langone, Mount Sinai and NewYork-Presbyterian — are treating tens of thousands of coronavirus patients in the city.
Those who need dialysis are also often on ventilators, but require the kidney treatment for days or even weeks after they are weaned off the breathing machines. Without dialysis, damaged kidneys cannot remove enough fluid and toxins from the body and patients essentially drown. The kidney problems caused by the coronavirus are exacerbated in those who require ventilator treatment, which itself can cause fluid to build up in the lungs.
Gov. Andrew Cuomo recently said that New York’s ventilator needs are beginning to plateau, and he has begun diverting the equipment to states in greater need. But hospital staff say that the extended nature of dialysis treatment means that shortages of fluids, trained personnel and even equipment there could just be starting.
In some New York hospitals, 30 percent of severe coronavirus patients need dialysis, a much larger proportion than is typical in ICUs, said Alan Kliger, chairman of the American Society of Nephrology’s task force for dialysis and Covid-19. “I’ve never seen anything remotely like this,” said Kliger, who has been in calls with hospitals and suppliers. “It’s stressing the whole system.”
A spokesperson for the city’s public hospital system, NYC Health + Hospitals, said it has enough supplies for now but is monitoring the situation closely.
Baxter, a major manufacturer of dialysis supplies, is seeing up to five times the normal demand for dialysis fluids like continuous renal replacement therapy in the U.S. and Europe, said spokesperson Lauren Russ. The company’s plants are “running at maximum production levels” to meet the unprecedented demand, she added. Baxter is working with FDA and CMS to send more supplies to New York hospitals without disrupting supply for facilities elsewhere.
That means placing an upper limit on what New York hospitals can order right now, further pressuring stocks in hospitals flooded with patients. Meanwhile other hot spots such as Chicago, New Orleans and Seattle are increasingly worried about their own supply as coronavirus cases mount, Kliger said.
FDA spokesperson Jeremy Kahn said the agency had no information to share regarding an interagency meeting and that there are no shortages of dialysis drugs listed on the FDA’s webpage.
“It is possible that there are distribution challenges leading to shortages of these products in certain regional areas,” he added.
About 30 million Americans already suffer from some form of kidney disease, which often requires dialysis or transplant. Kidney problems were the nation’s ninth leading cause of death in 2017.
If the severe coronavirus patients put on dialysis recover, the kidney disease symptoms usually dissipate too, a doctor treating them said. But the demand now has pressured even regular stocks that hospitals buy to help kidney failure patients without the coronavirus, and providers worry that standard dialysis equipment such as machines and infusion pumps and could be next. At the same time, few hospitals have the trained nursing staff available to administer dialysis, a time-consuming treatment, to a surge of new patients — and those nurses are falling ill with the virus.
A New York-based nurse with more than two decades of experience, who requested anonymity for fear of retaliation, said she is one of eight nurses in her dialysis unit who is out sick with the coronavirus due to a lack of personal protective equipment and close, prolonged contact with patients.
Her dialysis unit typically has about two dozen nurses on staff. The current personnel shortages are changing the way the remaining nurses provide care. “They’re just treating patients. They’re not looking at labs,” she said. “There’s not enough people to provide the treatment, period.”
Some hospitals are considering using baby monitors or other devices to allow nurses to monitor dialysis patients from afar, rather than stay in the room with them. Hospitals are also discussing a mass call for additional ICU-trained nurses and technicians with dialysis experience, much like earlier public calls for doctors.
In the meantime, morale on the anonymous nurse’s dialysis unit is suffering. She and her colleagues have had to beg for PPE, and the lack of respect may cause “a mass exodus” of the small number of nurses on dialysis units, she said.
“Not a lot of nurses go into dialysis. A lot of nurses are going to leave dialysis, because we don’t feel like we’re respected by the leaders and the physicians,” the nurse said. “We’re not respected, we’re not respected at all.”
Daniel Lippman and Darius Tahir contributed to this report.
U.S. races to stock up on dialysis supplies as kidney failure ravages virus patients
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