Dialysis could be rationed amid shortage of machines to treat sickest coronavirus patients

Fiona Loud, the policy director at the charity Kidney Care UK, said: “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 manufactures are working flat out to try and protect supplies.”

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.”

The main alternative to continuous dialysis is intermittent dialysis, typically used for patients needing long-term chronic care.  However, 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.

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

He added: “There are major efforts under way 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.”

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