Great Medical Programs of Delaware: Nephrology Associates: Caring for Delaware Kidney Patients
While COVID-19 is known primarily as a highly contagious respiratory tract infection, there is no way to understate the impact the COVID-19 pandemic has affected the health of the approximately 37 million Americans who are living with kidney disease and the healthcare providers who treat them.
People diagnosed with chronic kidney disease (CKD) and end stage renal disease (ESRD) and their doctors (known as nephrologists) had to rapidly adapt to limit susceptibility to COVID-19, particularly for those patients who undergo dialysis or have undergone kidney transplant as a treatment to live with kidney failure.
Dialysis is a treatment where a machine substitutes for a patient’s failed kidney function by externally filtering and cleaning the blood or bodily fluids to remove wastes and excess fluid. While lifesaving, this treatment also uniquely exposes patients to more risks for contracting COVID-19 or developing more serious complications.
Patients hospitalized with COVID-19 may be at risk to experience worsening of their kidney function, including even in non-elderly adults with previously normal kidney function or with no risk factors for kidney disease prior their infection. This may result in the need to treat the patient’s severe COVID-19 infection with dialysis. Additionally, those patients already on chronic dialysis are at higher risk to become hospitalized with COVID-19.
Patients undergoing dialysis or who been fortunate to have received a kidney transplant for kidney failure have weakened immune systems. Dialysis patients cannot easily isolate at home or socially distance, as they require regular in-person treatments (about 12 hours per week) in a dialysis clinic, with more resultant face-to-face contact with healthcare providers, frequent blood and urine tests, surgeries, and hospitalizations in order to live with treatment for their kidney failure.
Nephrologists are closely involved in the planning, preparation, and coordination of care in hospital settings, particularly in the intensive care unit (ICU) as these patients may unfortunately require dialysis treatment for kidney failure that develops in the course of their illness. Some patients require an extremely resource-intensive form of continuous dialysis performed around the clock due to the severity of their illness. Nephrologists learned from their colleagues in hard-hit areas such as New York Cityand Italy, and took steps to modify where and how they delivered dialysis in the hospital, both to conserve supplies and to protect their patients and employees.
With a strong focus on infection control and prevention, dialysis facilities, nephrologists, nurses, and ancillary staff adopted enhanced screening and isolation protocols and precautions, physical distancing, stringent cleaning and disinfecting of treatment areas and equipment, and use of personal protective equipment (PPE).
The COVID-19 pandemic also resulted in a quantum leap forward in the use of telemedicine. Nephrologists led in the early adoption of telemedicine visits, and by rapidly deploying virtual video visit technology, this allowed them to closely check in and remotely follow their patients’ progress in dialysis facilities at a safe distance in order to mitigate the spread of COVID-19 and to conserve PPE.
The pandemic unfortunately also further painfully exposed the healthcare disparities affecting African-American and Latino communities. Communities of color disproportionately suffer from a high burden of diabetes, high blood pressure, and cardiovascular disease, all of which are risk factors for the development of kidney disease but also for a more serious course of COVID-19.
Patients living with kidney disease, their families, and nephrologists who care for them are beginning to see brighter days ahead in the midst of the ongoing pandemic. Patients with kidney disease and their healthcare providers were placed at a priority for early vaccination. Ongoing public health safety measures, innovation, coordinated care, and addressing the socioeconomic determinants of health will continue to be needed to confront the healthcare needs of today and prepare us for the next crisis.
Various locations in Sussex County, Kent County and New Castle County