After ventilators, New York hospitals reel under shortage of dialysis machines to support COVID-19 patients
Hospitals across New York are facing a new problem, a shortage of dialysis machines to support COVID-19 patients with failing kidneys.
The situation is indeed dire."We only have nine or 10 machines, and now we have over 30 patients that need them," one physician who manages an intensive care unit in Queens, told NPR. "So it becomes a question of who the resource goes to, and these are very difficult decisions," the doctor added.
Dr David Charytan, director of the nephrology division at NYU Langone Health, pins the blame on poor federal planning. He told ProPublica that the government had not incorporated dialysis shortages into any pandemic planning.
The coronavirus shuts down the kidneys, affecting about one-third of the sickest patients who end up in intensive care, according to doctors. What is more, these patients did not suffer from severe diabetes or other kidney problems before COVID-19. One study suggested that such patients are less likely to survive the assault.
But data from China suggested a small proportion of patients experiences this condition. Experts do not yet understand how the virus manages to inflict damage on the kidneys.
With failed kidneys, patients cannot remove waste from the blood and keep their blood pressure under check. Dialysis machines take over these functions when kidneys become incapacitated.
There are other shortages too. To keep the ICU dialysis machines up and running, hospitals need filters and fluids. But they are running out of it. Further, these machines need highly specialized dialysis nurses. "Our intensive care unit nurses usually take care of two patients," Dr Steven Fishbane, head of nephrology at Northwell Health, New York's largest hospital network, told NPR. "Now it's one nurse for four patients," he added.
Fishbane explained the pandemic has placed a pretty substantial burden on supplies. "Everybody is running into shortages at this point," he explained. Many did not anticipate a situation like this. Calling it unprecedented, the Federal Emergency Management Agency said it was working to find a solution.
Doctors are already making difficult choices with ventilators, deciding who gets a shot at survival. They fear a similar situation will play out with dialysis machines. But doctors are trying to save as many people as possible. “The nephrologists in New York City are going slightly crazy making sure that everyone with kidney failure gets treatment,” Dr David S Goldfarb, chief of nephrology at the New York campus of the New York Harbor VA Health Care System, told The New Tork Times.
“Nothing like this has ever been seen, in terms of the number of people, needing kidney replacement therapy,” he added.
“Now we have to think harder about whether or not that patient truly needs it and can we manage them medically without dialysis another day so we can provide dialysis to someone who more urgently needs dialysis,” Dr Michael J Ross, the chief of the nephrology division at Montefiore Health System in New York, told The New York Times. “Those are not decisions we like to make," he added.