22/04/20

Statement on COVID-19 related acute kidney injury and intensive care capacity

Acute kidney Injury (AKI) refers to sudden failure of kidney function. In patients with a COVID-19 infection that requires treatment on an intensive care unit (ICU), over 25% of patients on ventilators develop severe AKI and require dialysis support.

Severe AKI on the ICU is usually treated by passing the patient’s blood through a machine that works 24/7 to remove the excess fluid and toxins that accumulate in the body when the kidneys are not producing sufficient urine. The treatment requires sophisticated machines that need sterile tubing sets and bags of fluids that contain the essential electrolytes that are removed along with the toxins and need to be replaced.

There is now a critical national shortage of the material required for the usual treatment in ICU. There are major efforts underway with all providers to source more tubing sets and fluid bags.

Kidney professionals across the UK are working with the NHS to try to ensure that patients on ICU who need treatment for AKI can receive it. We are working in regional renal and critical care NHS networks that have been set up to help deliver treatment for patients with kidney disease. This ensures that hospitals are helping each other in a coordinated way by sharing capacity and equipment. Kidney specialists are also working with ICU specialists to ensure that ICUs are supported to be able to manage patients with severe AKI.

An alternative to the usual ICU treatment is the shorter, more efficient, treatment that is currently used by many thousands of people in the UK who attend a dialysis unit two or three times a week or treat themselves at home. This ‘intermittent’ treatment is very widely used so we do not expect to have shortage of the tubing sets or fluids. It does however, require the installation of additional equipment and staff training to be able to deliver it in ICUs.

Some ICUs are already set up to deliver this treatment and are doing so, whilst others are adapting their structure to be able to do so. Staff from dialysis units are training their colleagues in ICUs to be able to deliver intermittent treatment. We are encouraging ICUs that can use intermittent treatment to do so where possible. We are also encouraging, where possible, the movement of patients from an ICU that may be affected by shortages in sterile tubing sets and bags of fluids to ICUs that can provide intermittent treatment. This is to allow the limited supply of these consumables to be used where patients are too unwell to transfer. In some centres, successful introduction of peritoneal dialysis on ICUs has provided additional support for the kidneys.

We wish to reassure patients on long term dialysis that this urgent situation is due to the huge increase in the number of patients in ICUs with acute kidney injury. We do not anticipate any issues with supplies of the material needed for long-term haemodialysis or peritoneal dialysis.

We are profoundly concerned about the shortage of consumables for treating AKI in ICUs and will do our best to ensure that all patients who need treatment will be able to receive this when it is needed.

This statement is supported by the UK kidney professional and patient organisations.