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

Dialysis patients still need access to out-patient surgeries. Originally posted here.

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.”

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