The Unprecedented, Unnerving World of COVID-19 and Kidney Care

Richard Lafayette Richard Lafayette, MD, FACP is Editor-in-Chief of Kidney News.

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The SARS-CoV-2 virus that causes the disease COVID-19 reached pandemic status in short order and has changed everything in our world. Modern living has been turned upside down in pursuit of efforts to control spread of this virus, identify infected patients, and treat them appropriately. Economies are faltering. Epidemiologists and public health officials are doing their best to find ideal practices while governments impose what they feel are appropriate guidelines and restrictions on populations. How this will evolve and the size of its ultimate impact on our lives is yet to be seen, but it is already certain to have an incredible influence on our health and well-being.

This pandemic has affected kidney care providers and our patients in both specific and general ways. It will continue to influence our daily routines for quite a while. Clearly, patients with chronic kidney disease, not only those with hypertension, diabetes, autoimmune diseases, or those requiring immunosuppressive therapy, are at high risk of severe complications of COVID-19.

We will need to protect our patients from exposure, diagnose and care for them when they get symptoms that may be COVID-19, and ensure that they get appropriate testing and therapy as indicated and available. This has already required huge efforts in just informing ourselves and our patients about this illness and its associated best practices, which are changing on a more than daily basis.

We have been tasked with communicating (in person, by phone, by mail) with employers, families, and community leaders to assure that our patients don’t sit in harm’s way, often on top of an already maximal work schedule. We continue clinic sessions, rounding in dialysis units, and rounding in hospitals where our skills are desperately needed. However, clinic sessions and dialysis rounds are increasingly being done with virtual visits to limit further spread of the virus. Dialysis patients are highly vulnerable given their general infirmity and need to gather in units. Outbreaks within dialysis units affecting patients and providers are already well reported. Policies are quickly being derived, although they are based on limited data and experience, to maintain their care while limiting the risks of spreading infections.

Inpatient care does not lend itself naturally to virtual visits, but this is being increasingly considered and modeled. However, not only are our kidney disease patients at risk and already needing care for complications of COVID-19 in our hospitals, but the illness carries a risk of acute kidney injury (AKI). Initial reports suggest an AKI rate of 3%–7%, clearly highest among critically ill patients. Urinary abnormalities may be frequent, including proteinuria and hematuria. Kidney imaging may be abnormal. The abnormal imaging and urinary abnormalities suggest direct involvement by the virus, together with risks of sepsis and medication-induced injury. We will certainly learn more with each passing day and each summary report of experiences with this pandemic.

These unprecedented changes to society and to kidney caregivers’ workplaces are sure to impose unusual stresses and anxieties on all of us. Caring for our patients—those known to be affected or not—leaves us all vulnerable to infection and its complications. We worry about the very real risks of transmitting illnesses to our family, friends, and community.

As healthcare workers, we have already committed ourselves and are obligated to do our best for our patients and our community. We will harness our best abilities and provide the best care and comfort that we can. We must work together to figure out how to meet this challenge most effectively, advance our understanding of this disease, and become ever more prepared for the next challenge around the corner. Certainly, we hope to see that closing non-essential services and travel, as well as teaching social distancing, reduce the spread of this virus. We also must hope that treatments beyond supportive care, such as remdesevir or hydroxychloroquine and azithromycin, can actually reduce viral growth and improve outcomes. New treatments will arise and ongoing research will pave the way to a more secure future.

We hope this issue of Kidney News, and ongoing updates in Kidney News Online as well as future issues will help to inform you and prepare you to deal with COVID-19 and continue your professional life. Please feel free to share your thoughts and experiences with us at KN, or in ASN Communities. Be safe and well.