Industry Voices—More attention to patient-centric kidney care policies needed amidst COVID-19 pandemic

A patient receives hemodialysis
There’s simply no time to waste in uncovering and addressing how the virus could affect the nation’s vulnerable kidney population. (Getty/Mailson Pignata)

Since COVID-19 reached the U.S., normal day-to-day life has come to an unprecedented, screeching halt. While work, school and commerce have slowed, what we have learned—and continue to learn—about COVID-19 is moving at what seems like light speed.

Several short months ago, few people were wearing masks in public because we assumed only those individuals showing symptoms were contagious. We found misplaced comfort in the hypothesis that children are less severely affected by the virus than adults. And we focused on the respiratory implications of the virus—with little expectation that COVID-19 might ravage the body in other ways.

Healthcare providers and scientists have learned so much, so quickly, about this virus that continues to evolve. Perhaps one of the most surprising is the impact COVID-19 has on the kidneys. Early anecdotal stories about renal infarction and frequently clotting dialysis machines quickly revealed that one of COVID-19’s most lethal surprises is infection and hypercoaguability that can cause acute kidney injury (AKI) and kidney failure in individuals with no prior history of kidney disease.

It’s frightening to think that someone with no prior history of renal disease could suddenly lose kidney function as a result of a COVID-19 diagnosis. It’s even more frightening to imagine all that we still don’t know.

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For the millions of Americans already living with kidney disease and kidney failure—many of them minorities with other health problems—COVID-19 has brought a host of frightening unknowns. How much of a greater risk is there for individuals with common co-morbidities like diabetes and heart disease? What role does ethnicity play in mortality rates? Does one’s existing chronic kidney disease mean they are more likely to suffer from AKI if they contract COVID-19?

These are critical questions that members of the kidney community are committed to addressing as part of our ongoing efforts to safeguard the health of Americans with kidney disease. The disparities and challenges they face—even in the best of circumstances—make rapid research and investigation all the more important as we continue the uphill battle against COVID-19.

During this extremely difficult time, Americans with kidney disease and kidney failure need a safe way to receive care and meet their basic needs—like transportation to dialysis, nutrition, medications and appropriate personal protective equipment. That’s why groups like the National Renal Administrators Association are supporting providers with education, resources, and open forums to discuss challenges and learn from one another in order to provide optimal patient care. That's why they are also engaging with policymakers to ensure that the needs of kidney patients are considered in emergency orders, regulations and legislation.

If the past several months are any indication, we are likely to discover more unfortunate surprises about the devastating impacts of COVID-19 in the weeks and months to come. That is why there’s simply no time to waste in uncovering and addressing how the virus could affect the nation’s vulnerable kidney population.

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As a first step, policymakers should move to ensure patients diagnosed with AKI or peritoneal dialysis can continue to receive home dialysis once they leave the hospital rather than force them into another surgical procedure so they can receive dialysis at a facility.  When discharged, we don’t want patients to have to go through catheter placement procedure as the length of their AKI was unknown.

The Centers for Medicare & Medicaid Services (CMS) can make this happen by eliminating the current regulatory restriction on AKI patients receiving dialysis at home. Congress can help too by funding research to understand the impact of COVID-19 on the kidneys, as well as by directing CMS to provide individuals with kidney disease with treatment options that allow them to stay at home and out of outpatient departments or infusion centers, to reduce the risk of exposure to the virus.

As Americans hunker down and try to stay healthy until COVID-19 transmissions slow and a vaccine is developed, we can only hope that time passes quickly with fewer frightening discoveries along the way.

We want to thank the heroic front-line workers who have cared for individuals with kidney disease and others in the kidney community who have been there for our patients, including health care professionals, providers and manufacturers. We must also use this time to work together—and quickly look for ways to protect those most at risk.

Maria Regnier is president of the National Renal Administrators Association and senior director of dialysis services at Sanford Health.