UPDATE: Govt alerts trusts over ‘critical’ shortage of dialysis kit for covid patients

The government has now warned of “severe disruption” to supplies used to treat acute kidney injury in intensive care.

Although hospitals are able to deploy alternative equipment not typically used in intensive care, this is logistically challenging and can carry increased risks for patients.

The Intensive Care National Audit and Research Centre has said 29 per cent of ventilated coronavirus patients require dialysis, as they are also suffering from acute kidney failure. Dialysis machines are used to remove waste products and excess fluid from the blood when the kidneys stop working properly.

Due to the sharp increase in demand, “continuous” dialysis machines and the fluids needed to run them are running low, along with other consumables such as the tubing needed to connect a patient to the machine.

Suppliers Baxter Health Care Limited, Fresenius Medical Care (UK) Ltd and B Braun Medical Ltd, which make up 70 per cent of the NHS market, all reported dwindling supplies of the kits and fluids, according to a supply distribution alert from the Department of Health and Social Care.

The Kidney Care UK charity told HSJ it warned the Department of Health and Social Care about the shortages on 7 April.

A week later, on 15 April, official guidance issued by NHS England, said “the need to provide renal replacement therapy to an increasing number of critically ill patients is likely to exceed machine capacity”, before setting out a range of alternative options for treatment.

Donal O’Donoghue, a renal consultant and Royal College of Physicians registrar, told HSJ: “While we’ve been able to secure more ventilators in hospitals, the availability of continuous veno-venous hemofiltration machines which are used to treat those who have acute kidney injury is now critical in many intensive treatment units.

“NHS England [is] aware of the situation and its urgency, but there’s clearly an issue here with supply.”

Doctors, including one who works at Barts Health Trust, have also spoken on Twitter about potentially having to ration treatments.

A spokesman for DHSC said: “While the rapid increase in demand for renal dialysis has placed additional pressure on staff and equipment, there is currently sufficient capacity in the system to support treatment of both covid-19 and regular dialysis patients in the NHS. Guidance has been provided to clinical teams to support them in maintaining provision of dialysis treatment.”

Alternatives

The main alternative to continuous dialysis is intermittent dialysis, which is typically used for patients needing long-term chronic care. This is usually adequate, but many hospitals do not have these existing dialysis services, which makes them logistically difficult to provide. The machines are also needed for chronic kidney patients.

Another alternative is acute peritoneal dialysis, which NHSE’s guidance says carries a risk of “bowel injury during insertion, leak [from the catheter] especially in the early phase, [and] in prone position, [and] peritonitis”. It involves a catheter being inserted into the stomach, and many hospitals do not have the skilled staff to carry this out.

A protocol document, posted on Twitter by the Renal Association, suggests King’s College Hospital Foundation Trust has begun using this alternative.

Indranil Dasgupta, a nephrology consultant at University Hospitals Birmingham Foundation Trust, told HSJ that Heartlands Hospital is currently using intermittent dialysis, but may have to also consider peritoneal dialysis.

He told HSJ: “There are major efforts underway with all providers to source more tubing sets and fluid bags by the NHS. Kidney professionals are working with the NHS to try to ensure that patients on intensive care who need treatment for acute kidney injury can receive it. Only one third of hospitals that have an intensive care unit also have a dialysis unit so this shortage is even trickier for them as they have no back up.”

Fiona Loud, policy director at the charity Kidney Care UK, said the concerns were flagged to DHSC earlier this month. She added: “This shortage must be treated as an exceptionally urgent NHS priority. We need to see that national innovation, reserves and suppliers have all been called on to resolve this, and the charity are urgently calling upon the government to make public its immediate and short term contingency plans.”

An Association for British HealthTech Industries spokesman said: “Global demand for these products has tripled and manufacturers are working flat out to try and protect supplies.”

Story updated on 23 April following the alert issued by the Department of Health and Social Care