The current COVID-19 pandemic has affected many from all walks of life, some much more than others. It is noteworthy to look at COVID-19 and how it affects the kidneys, with infected patients having displayed kidney damage. Data has shown that COVID-19 can have deleterious effects on patients with chronic kidney disease (CKD) as well as those who are immunocompromised, such as kidney transplant recipients and patients on dialysis.
In this Q&A, our kidney doctor Dr. Loh Ping Tyug shares more on how COVID-19 can affect the kidneys.
Does COVID-19 infection put patients with CKD at a higher risk?
Yes. Most of the severe cases and deaths due to COVID-19 occur among the elderly and those with underlying chronic conditions. Patients with chronic kidney disease fall under these categories. They are more likely to suffer severe complications if they contract COVID-19.
The possible reasons are as follows:
- CKD patients are more likely to have cardiovascular disease, including high blood pressure and susceptibility to heart attacks and strokes. These are known to increase the risk of death.
- Patients with CKD usually have diabetes as well, a condition that has been shown to have higher risk of developing complications due to COVID-19.
- CKD patients are commonly immunosuppressed.
How does COVID-19 affect the kidney function?
SARS-CoV-2 (COVID-19) antigens were found in kidney tubules suggesting that this coronavirus can infect the human kidney directly; causing acute kidney injury (AKI).
COVID-19 can also affect the kidneys through inflammation from the cytokine release syndrome. COVID-19 have also been shown to damage blood vessels, causing multiple blood clots in the kidneys. Hypotension and dehydration due to COVID-19 can also lead to further kidney injury.
Are there special precautionary measures that patients with kidney diseases should take to reduce risk of exposure to COVID-19?
There are no specific precautionary measures for kidney patients. They should follow the general precautionary measures given to the public.
We advise our kidney patients to avoid crowded places and practice safe distancing as much as possible. This applies even when they are with their family members, helper or personal caregiver. For example, I would always encourage my kidney patients to learn how to measure their own blood pressure or blood sugar as much as possible, rather than having someone come in close contact to do that for them.
Other advices include frequent handwashing, masking up when heading out and buying adequate necessities – or even getting someone to help buy – so that they do not have to go out too often.
Is there any specific food that kidney patients may have to stock up on just in case supplies run out due to panic buying?
Generally, patients with kidney disease are advised to eat less of something rather than more of anything. However, patients on dialysis need to consume more protein.
Dialysis patients are encouraged to have a higher protein intake than the average individual because some amino acids are removed during dialysis. Often, they would also be advised to take more egg whites. We were assured by our government that there would be enough supply so there is no need for patients to stock up and participate in panic buying.
Is it safe to continue dialysis treatments during COVID-19?
It is especially important to protect dialysis patients who need to get out of their house regularly for dialysis treatment. Although hemodialysis patients are highly susceptible to COVID-19 and dialysis centers are considered high risk areas, death rate due to COVID-19 is considered low. However, if dialysis patients miss their regular dialysis session, they will put themselves at higher risk of death due to arrhythmia caused by high potassium level.
I strongly advise dialysis patients to continue their regular dialysis treatment and not to miss dialysis session due to fear of going out.
How can we ensure patients stay safe while continue their dialysis and other treatments during COVID-19?
Apart from the general precautionary measures such as safe distancing, temperature monitoring, SafeEntry check in- and out and the standard practice of disinfection of dialysis machines, chairs or beds after each patient, our dialysis center also limit one accompanied caregiver to one patient. This helps to minimize crowds around the waiting area and allows safe distancing.
There is also a clear segregation of staff and patients between shifts. Our patients are strongly encouraged to come for their dialysis treatment at their designated time so as to minimize crowding while waiting for dialysis staffs to perform disinfection.
Once patients complete their dialysis treatment for their day, we would encourage them to head home as soon as possible to avoid lingering around the center.
There is also more than one-meter distance between each dialysis station separated by a clear partition so that patients have minimal contact with one another.
Should patients wear masks during dialysis?
All dialysis patients and their caregivers are required to mask up throughout the entire dialysis treatment.
If a patient presents with a fever (>37.5°) or exhibit flu-like symptoms, can they delay dialysis until they get well? Are there alternatives?
If patients are unwell, display acute respiratory symptoms or fever, they should call the center ahead of their scheduled dialysis treatment. They will then be advised to visit the nearest PHPC clinic and take a COVID-19 swab test. For those who are severely short of breath, they should call for an ambulance or have their family bring them to an emergency department immediately.
After the patient completes the swab test and is clinically stable, we will then schedule their dialysis at the last shift of the day. They will have their dialysis in an isolated area with one dedicated nurse equipped with full personal protection equipment (PPE) to attend to them.
If patients recover from COVID-19, will they recover from COVID-19-inflicted AKI as well?
Some patients with COVID-19-inflicted AKI would require dialysis support during the period where the kidneys are not working. Some may recover their normal kidney function but there are others who may not recover completely. Among these patients, some may go on to develop hypertension. More data is required over a longer period to get a clearer picture.