Industry Voices—Policymakers must prioritize immunocompromised dialysis patients by allowing providers to allocate, distribute therapies

We’ve reached the unimaginable two-year milestone of the COVID-19 pandemic.

As we reflect on the last few years, we remember the incalculable loss and devastation endured by so many around the world, across the country, and in our own communities. Our daily lives and those of our patients were upended and shadowed with tremendous fear and uncertainty about the realities of living through a global pandemic.

While navigating through these years of unforeseen events, the kidney community came together and pivoted to a multipronged effort to continue providing life‐saving dialysis to those with severe kidney disease, while grappling with a virus we knew little about. The COVID-19 pandemic united our community and shed light on important policy changes that need to be addressed to protect our patients and providers against future crises that we may face.

For people on dialysis, Centers for Disease Control and Prevention (CDC) recommendations early in the pandemic were scarce and difficult to follow. Those who required in-center dialysis did not have the option to stay at home. Treatments require going to a center for care, typically three times a week for four hours. Understanding the necessity of regular and consistent care, our community devised a response plan to deal with the challenges our patients faced.

United in our mission to serve our patients even in a worldwide health crisis, leading dialysis providers collaborated to establish the Dialysis Community Response Network (DCRN) which, enabled us to coordinate care and provide treatment to patients across our nation who were COVID-19 positive.

For patients who did contract COVID-19, this network established isolation centers and shifts in which we were able to provide dialysis to COVID-19 positive patients, while also reducing exposure risks for staff and other patients. Through real-time coordination and information sharing, clinics were able to provide uninterrupted care even during the early days in March 2020.

Our community also took a proactive approach to patient care, beyond our role as dialysis providers. Our joint efforts to treat COVID-19 positive patients with new therapeutics, such as monoclonal antibodies (mAbs), exposed the constantly changing and inadequate policies related to the allocation and distribution processes for these therapies.

Although end-stage renal disease (ESRD) is a comorbid condition that puts patients at a higher risk of death from COVID-19, our community was not included in the priority distribution for these medications. In addition, when the distribution for monoclonal antibodies changed late in the pandemic to a state-by-state allocation system, dialysis facilities had to interact with each state health department to procure the therapeutics, creating confusion and inefficiency for multistate providers.

While federal guidelines prioritized patients at higher risk of progression to hospitalization or mortality from COVID-19–using risk factors including age and comorbid conditions, according to a March 8, 2022, JAMA study–patients at the highest risk of severe disease were less likely to receive mAb therapy.

Despite the challenges related to accessing these therapies, when and where available, we were able to administer and test the efficacy of mAbs for ESRD patients with COVID-19. Facing limited access to therapeutics, we implemented communications strategies to maintain the information flow on best practices among a nationwide network of medical directors. This regular communication allowed us to impart information in real-time teleconferences and positively impact patients across the country.

Because of patients’ familiarity with their dialysis facility and staff, patients were willing to receive these treatments in coordination with their dialysis treatments.

When the first COVID-19 vaccines became available in early 2021, our community leaders advocated with the CDC for priority vaccination status for patients and staff (including transportation providers and family members who transport loved ones to dialysis appointments). Given patients’ congregate treatment settings, high vulnerability to infection and poor outcomes if infected, gaining priority vaccination status for dialysis patients and providers was critical to protect our community.

Again, dialysis patients were not prioritized for receipt of these vaccines. In response, the industry advocated aggressively, and ultimately received an allocation of vaccines, which markedly improved vaccination rates in our population and undoubtedly saved lives. To address vaccine hesitancy, our community produced educational videos, established education campaigns within dialysis facilities and sponsored community vaccination days to boost awareness about vaccinations to reduce hospitalizations, improve outcomes and save lives. 

For the kidney community, advocating for uninterrupted access to care went well beyond pushing for early access to vaccines and administering mAbs. The inherent challenges posed to long-term dialysis patients underscored the need for reduced exposure to risks in any possible way. We adopted telehealth visits, allowing patients to remain at home or to see their physicians virtually. For dialysis patients who were candidates for home dialysis, our physicians and staff helped with education and getting those interested set up with dialysis in the home.

The successful adoption of telehealth visits by physicians and patients is evidence that this model of care should continue beyond the current public health emergency, and the high satisfaction of patients who were able to switch to home dialysis should also inform our treatment protocols going forward.

On the research front, our community engaged in proactive research to assess the longitudinal anti-RBD antibody levels among patients on dialysis immunized with mRNA vaccines. The results of this study will enable our providers to assess risk and vulnerability levels of patients for breakthrough infections based on antibody levels. The findings raise concerns over the durability and effectiveness of vaccines in our vulnerable patient population and underscore the need for booster doses and effective therapeutics for kidney patients who are infected with COVID-19.

COVID-19 presented many challenges to people living with kidney disease and the healthcare providers who care for them. But what we have learned about ourselves and our unified, powerful community is that, together, we are strong enough to face any challenge and will always do whatever it takes to care for our patients. Looking to the future, we must continue to advocate for policies at the state and federal levels that prioritize the unique needs of our patients.

The innovative protocols and tremendous care coordination efforts established during the pandemic and developed with our unyielding commitment to our patients is something that we will continue building upon. The access to care issues we faced and responded to during the pandemic have underscored the importance of necessary changes to existing policies related to designating kidney patients as immunocompromised and the allocation of therapeutics.

Together, working collaboratively and proactively with policymakers, we can face future healthcare crises with the same dedication and teamwork mentality as we have shown over the past two years.

Brigitte Schiller, M.D., is chief medical officer at Satellite Healthcare. Mary Dittrich, M.D., is executive vice president and chief medical officer at U.S. Renal Care.