LULU GARCIA-NAVARRO, HOST:
Lack of testing, a struggle to find ventilators - all that has hampered dealing with the pandemic here in the United States. But doctors in hard-hit hospitals are now saying the problem is not enough dialysis equipment. Fred Mogul at WNYC reports that the shortage is leading to hard decisions inside New York hospitals about who gets treated and who doesn't.
FRED MOGUL, BYLINE: At the Manhattan VA, Dr. David Goldfarb is getting an update on the most critical patients.
DAVID GOLDFARB: Go ahead. Let's just talk about the patients. That's all.
MOGUL: Dr. Seeta Lakshmi Iyer tells him about one man with COVID-19 who's on a ventilator.
SEETA LAKSHMI IYER: His potassium is 4.1, and his bicarb is 25.
MOGUL: This patient might need dialysis, which means running his blood through a machine to remove waste because his kidneys are struggling.
GOLDFARB: So he could have chronic kidney disease, or he could've had AKI.
MOGUL: That's acute kidney injury. But the good news is he's responding to medication.
IYER: I don't think he needs dialysis at this point since he's making good amount of urine.
MOGUL: Goldfarb recorded the exchange on his phone. Later, he says this man is relatively lucky. Almost one-third of coronavirus patients on ventilators also have kidney failure.
GOLDFARB: They are critically ill. They are not doing well. And every day, a couple of patients have died.
MOGUL: Goldfarb says, so far, at the three hospitals where he works, they have enough dialysis equipment and staff. But three doctors who work elsewhere in the New York City region describe much more dire situations. They say no one wants to call it rationing, but that's exactly what's happening.
UNIDENTIFIED DOCTOR: We only have nine machines or 10 machines. And now we have over 30 patients that need them.
GOLDFARB: That's a doctor who manages an ICU at a hospital in Queens. We're not naming him because he fears losing his job for speaking freely.
UNIDENTIFIED DOCTOR: So it becomes an issue of who the resource goes to. And those are very difficult decisions.
MOGUL: It's not clear exactly how the coronavirus damages kidneys. Dr. Benjamin Humphreys at Washington University Hospital in St. Louis says the virus could be infiltrating kidneys directly, or it could be an indirect effect from COVID patients' tendency to develop blood clots.
BENJAMIN HUMPHREYS: We don't have any other clues as to what differentiates patients that do develop kidney failure who are infected with COVID with those that don't.
MOGUL: The widespread need for dialysis has come as a surprise. Research from China didn't indicate major kidney problems, particularly not among patients who don't already have other problems like diabetes. But that's what American doctors are seeing now.
Dr. Steven Fishbane is with Northwell Health, New York's largest hospital network.
STEVEN FISHBANE: Everybody is running into shortages at this point.
MOGUL: The shortage isn't just dialysis machines but also the unique fluids and filters they use. And there also are not enough of the highly specialized dialysis nurses, many of whom have gotten sick with COVID-19 themselves. Fishbane says hospitals need to get creative.
FISHBANE: These are intensive care unit nurses who usually might take care of two patients. Now it's one nurse for four patients.
MOGUL: Doctors at at least two hospitals in the city say they're coping with the shortage by taking patients off 24-hour continuous dialysis. Instead, they're having two patients share a machine, and each gets 12 hours. And sometimes, doctors and nursing supervisors have to choose which patients will simply go without dialysis, based on their prospects of surviving. Again, the doctor in Queens.
UNIDENTIFIED DOCTOR: There are hospital ethics councils. There are palliative care teams. But the kidney doctors are the ones deciding who's in the worst failure at a given time.
MOGUL: So is a dialysis shortage actually killing patients in the ICU? It's hard to say. The virus is what's killing patients, mostly by shutting down the lungs. Doctors say it is possible to get the lungs working again, but it's hard. And these patients need all the help they can get from the kidneys or from the best mechanical substitutes available.
For NPR News, I'm Fred Mogul in New York. Transcript provided by NPR, Copyright NPR.
