Renal patients at greater risk during the pandemic

Lack of access to timely dialysis, increased chance of contracting COVID risk factors

Renal failure patients on maintenance dialysis are turning out to be one of the biggest casualties of COVID-19 epidemic in the State, with an increasing number of them succumbing to the disease or going into serious renal complications because of lack of access to timely dialysis.

Nephrologists across the State say that they have been regularly losing patients on dialysis to COVID-19, especially for the past two months.

“Dialysis patients, because of their immunocompromised state and other co-morbidities, constitute an extremely vulnerable group. We are trying to educate our patients about their vulnerability and the extreme care they and their family need to take to prevent them from contracting COVID-19. But the need for frequent travel to dialysis units and mingling with other patients and staff during dialysis shifts are an unavoidable risk,” P. Krishnadas, consultant nephrologist at Palakkad district hospital, said.

Mortality rate is as high as 25% amongst dialysis patients contracting COVID-19. Kerala has a population of over 10,000 under maintenance dialysis.

Doctors also fear that a potential crisis could be brewing, as across the State, smaller dialysis centres are finding it increasingly difficult to operate as more patients are contracting COVID-19, passing it on to dialysis technicians and other renal patients.

All maintenance dialysis patients are attached to specific dialysis centres on fixed twice/thrice-a-week dialysis schedules. Even a temporary shut down can upset the dialysis schedule and lead to severe complications for patients.

The dialysis unit of the Department of Nephrology at the Government Medical College Hospital, Thiruvananthapuram, had to be shut down last week after three dialysis technicians contracted COVID-19. A private hospital in Palakkad had to shut down its dialysis unit after six dialysis patients and two technical staff tested positive.

Nephrology departments in hospitals are also under tremendous stress as the number of COVID-19 patients going into renal failure, necessitating dialysis, is rising steadily. Mortality rate is as high as 60% in this group.

The pressure on dialysis centres could worsen in the coming weeks when COVID-19 cases surge and those on routine dialysis will have to fight with COVID-19 patients for access to dialysis. This could push up mortality eventually in both categories, nephrologists fear.

“The evolving situation on the ground is very frightening, about which policy makers and administrators seem to be totally unaware. We need clear guidelines on how we can manage this special group of patients. Regular screening of dialysis patients for COVID-19 should be possible,” a senior clinician said.