As COVID-19 patients began to flood New York City area hospitals in February, they developed acute kidney injury (AKI) at rates much higher than anyone expected from a respiratory virus. By mid-April, the need for renal replacement therapy in these patients was pushing the system to the breaking point, as healthcare providers and manufacturers scrambled to find equipment and supplies.
Hospitals used creative means to cope—including contacting the top decision-makers at the largest companies directly to plead for help and finding ways to treat more patients with a limited number of machines.
Because COVID-19 is categorized as a respiratory infection, a great deal of attention was given to the need for ventilators early on. Reports from China and Italy did not indicate that AKI was a major concern, so American nephrologists were taken by surprise at the high rate of AKI when COVID-19 patients poured in.
A link to Kidney International of COVID-19 patients admitted to the 23 hospitals in New York’s Northwell Health system reported that of 5449 patients admitted, 36.6% developed AKI, and 5.2% of the total—some 285 patients—required dialytic support.
A study in CJASN that included several hospital systems reported: “An informal survey of our intensive care units (ICUs) this week demonstrates that 20%–40% of intubated ICU patients have AKI that necessitates kidney replacement therapy.”
Steven N. Fishbane, MD, chief of the division of nephrology at Northwell Health, said he tried to plan ahead and order equipment for 10 of the hospitals in the system: “About two weeks before the wave really hit us, we modeled out what it would look like if this hit us a soft glancing blow, if it hit us medium, or if it hit us with complete fierce intensity. I remember looking at it and thinking, oh God, in the worst model, we would need about 60 new portable dialysis machines, 60 new portable reverse osmosis machines, [and] 24 new CRRT machines. I spoke to our procurement people and they said to order the entire thing.” The machines arrived in time to be put into use before the biggest wave of patients arrived—and that wave proved to be about 10% worse than even his worst-case scenario, Fishbane said.