COVID-19

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ASN has recently advocated for numerous policies that address the current kidney care system as well as the effects of COVID-19 on kidney patients and kidney care professionals.

The COVID-19 pandemic has posed unique challenges for the 37 million Americans affected by kidney disease and the physicians who care for them as parts of the nation transition to various phases of reopening. ASN recently collaborated with the National Kidney Foundation (NKF) on behalf of kidney patients and kidney care professionals in advocacy efforts on two COVID-19 related policies.

Discriminatory Ventilator Policies

COVID-19 has created challenges for states and hospital systems that face limited medical resources, including ventilators. Blanket crisis-management policies that were previously developed or under consideration by states and hospital systems arbitrarily deprived certain patients, including kidney patients, of life-saving interventions, such as ventilation.

ASN and NKF wrote to both the National Governors Association and the National Conference of State Legislatures requesting that they urge their members to ensure their states, and the healthcare systems therein, to not tolerate this type of discrimination.

ASN also alerted the Department of Health and Human Services (HHS) of potentially discriminatory policies, specifically flagging those concerning kidney patients. The HHS Office for Civil Rights (OCR) recently took enforcement measures against states with discriminatory ventilator rationing guidelines. OCR also collaborated with the Federal Emergency Management Administration/HHS Healthcare Resilience Task Force to release official Crisis Standards of Care and Civil Rights Laws guidance for resource-constrained settings.

The OCR guidelines are available on HHS.gov, and ASN members are encouraged to file a complaint with the HHS Office for Civil Rights if they encounter instances of discriminatory policies or resistance to the policies outlined in the guidance.

Reopening the Nation Safely

While the COVID-19 pandemic has begun to slowly subside in portions of the country, HHS is beginning to consider and establish guidelines to reopen the nation. ASN and NKF sent a list of policy recommendations to HHS Secretary Alex Azar for consideration. These recommendations urge the administration to consider the unique needs of kidney patients, who are particularly vulnerable to COVID-19 infection, and the kidney care professionals who care for them as the country reopens.

In the letter, ASN and NKF encourage the administration to adopt policies and procedures “to ensure kidney patients, their families, and clinicians have adequate access to personal protective equipment, priority access to COVID-19 testing, and early access to a vaccine once it is developed; support end stage renal disease (ESRD) patients’ ability to safely access dialysis services and other related care; prioritize the safe resumption of organ transplantation, which has significantly declined as a result of COVID-19; extend and build upon temporary policy changes that may be required to meet the ongoing needs of kidney patients; and address the needs of patients who develop acute kidney injury (AKI) as a result of COVID-19 infection.”

CMS Regulations on AKI and Peritoneal Dialysis

As reported in the article in this issue, “More Than One-Third of Hospitalized COVID-19 Patients Develop AKI, Study Finds,” the scope of AKI associated with patients hospitalized with COVID-19 is just beginning to be understood and more widely reported. Many of these AKI patients were started in hospital with peritoneal dialysis (PD). Currently, CMS regulations do not allow in-center dialysis facilities to perform PD nor do they allow AKI PD patients to be discharged directly to home. This has complicated care for these patients, often necessitating that they undergo another procedure to switch to hemodialysis. ASN is working with CMS to address this issue in upcoming rulemaking this summer.

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