National Kidney Foundation Urges Clarity and Flexibility on Elective Surgery Procedures During COVID-19 Outbreak

Dialysis patients still need access to out-patient surgeries

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Mar 19, 2020, 09:58 ET

NEW YORK, March 19, 2020 /PRNewswire/ -- The National Kidney Foundation is extremely grateful to the Administration for issuing a clarification on "non-essential" elective medical procedures during the COVID-19 outbreak. In a letter sent yesterday to the Department of Health and Human Services (HHS), the National Kidney Foundation urged the Administration to distinguish which procedures are truly elective and non-essential from procedures – like organ recovery and kidney transplant - that have immediate, significant, and life-long benefits for patients. Without this clarification, the organizations responsible for procuring and transporting deceased donor organs to transplant centers may not be able to enter the hospital, let alone facilitate the organ recovery surgery. These delays and barriers would effectively preclude most life-saving kidney transplants for the near term.

"We are grateful to the Administration for clarifying that transplantations are an essential surgery which can be performed safely if a hospital feels they have the staff and resources available during the COVID-19 crisis," said Joseph Vassalotti, MD, Chief Medical Officer, National Kidney Foundation. "While some may think prospective transplant patients can remain on dialysis until the threat of COVID-19 has passed, it is important to recognize that this might not be in the patient's best interest".

Transplant surgeries from a deceased donor are, by their nature, unpredictable and cannot be scheduled in advance. The median nationwide wait time for a kidney is four years, during which time a patient's health and quality of life is significantly diminished.¹ Preliminary data from Wuhan, China suggest that hemodialysis facilities are exceptionally high risk areas for coronavirus transmission and dialysis patients at high risk of poor outcomes including death from infection.²

"We encourage the Administration to now also clarify that hospitals can proceed with dialysis access procedures for patients with kidney failure who are currently on hemodialysis using a central venous catheter (CVC), and patients with advanced chronic kidney disease (CKD) who are approaching dialysis," added Dr. Vassalotti. "Delays in placement of optimal hemodialysis vascular access or peritoneal dialysis catheters will increase the risk for hospitalization for these already vulnerable patients."

Delay in access placement can increase a patient's risk for blood stream infections and death. For those patients not yet on dialysis, delay in placement of vascular access may result in patients beginning dialysis in the hospital, rather than at home or in a dialysis center. This will only strain hospital resources, especially emergency room resources, as the outbreak continues. To the extent that hospitals can balance surgical procedures as usual while still implementing any necessary preparations for the growing threat of COVID-19, NKF believes it is prudent, and in the best interest of patients, to continue with these necessary vascular access procedures.

"Kidney disease doesn't go away just because of coronavirus," said Kevin Longino, CEO of the National Kidney Foundation and transplant patient. "We applaud the Administration for their efforts to protect transplant patients during this outbreak and look forward to working with them to ensure that kidney patients can also continue to receive out-patient surgeries and procedures necessary to safely continue with dialysis treatments."

Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease—and more than 90 percent aware of it. 1 in 3 American adults are at risk for chronic kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end-stage renal disease (kidney failure).

About the National Kidney Foundation
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.

¹ United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018.
² https://www.medrxiv.org/content/10.1101/2020.02.24.20027201v2

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SOURCE National Kidney Foundation