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Covid, your kidneys and you



The cases of Covid-19 have been trending down and, hopefully, this continues. In spite of this, a lot of patients remain at risk, may currently be suffering from or may have recovered but still have questions. Today we focus on how Covid may affect our kidneys and their function.

People who already have damaged kidneys have the greatest risk for more injury if hospitalized for Covid-19, but kidney injuries are common even in people not previously known to have kidney disease. Diabetes, high blood pressure, vascular disease and older age all raise the risk of kidney problems.

Hospitalization is always hard on kidneys. Even before Covid-19 hit, hospitalization — especially an ICU stay — raises the risk of acute kidney injury (AKI). Normally, about 20 percent of hospitalized patients have AKI. Only about 4 percent though are at stage 3, the most serious.

During this pandemic, some centers abroad reported that up to 76 percent of ICU patients with Covid-19 had kidney damage, with a third needing dialysis, a process in which a machine performs the kidney’s blood-filtering work. The mortality rate for those with AKI was 41 percent overall and 52 percent for ICU patients. Half of those who were discharged alive recovered their kidney function.

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Locally the experience is not that far off, and the amount of acute injury and failure has been unexpected and dramatic. It is too early to know whether survivors of serious Covid-19 will have long-lasting kidney damage, but a lot of us are worried. People are just waking up to the fact that the kidney is an unappreciated manifestation of Covid-19, and one that is pretty important. Not to sound alarmist, but my greatest fear is the arrival of post-coronavirus kidney disease.

Unfortunately, I’ve seen my share of patients who’ve had to continue dialysis even after they’ve been discharged because their kidneys were unable to recover. And even if they do recover from AKI, these patients remain at higher risk for developing chronic kidney disease (CKD) later.

CKD is already a major problem for the country, costing us billions of pesos. In the Philippines, about 10,000 to 15,000 patients start dialysis each year, with thousands more that should but are unable to afford to do so, while thousands more stop because they succumb to the effects of living a life supported only by dialysis. Transplantation would be a way out of dialysis for these patients but acccess to that life-saving surgery can be even more prohibitive to majority of our countrymen.

An important question is whether coronavirus will cause a net increase in dialysis patients. It remains to be seen how deaths of people already on dialysis who catch Covid-19 will balance out new dialysis patients. We need to closely monitor whether demand for dialysis during this pandemic has increased.

It is also unclear whether Covid-19 will lead to an increase in demand for kidney transplants. Although I voluntarily stopped performing transplants when the pandemic started, I do encourage all patients with permanent kidney failure on dialysis to consider transplant. With the lower number of new Covid cases it appears that you’ll hopefully see us performing more transplants once again, because while dialysis keeps people alive, it does not return them to normal. A 30-year-old on dialysis will have roughly the same life expectancy of a 55-year-old not on dialysis.

Doctors aren’t sure why the kidneys are so vulnerable. One probable reason is that many hospitalized Covid-19 patients are critically ill, and that’s hard on the kidneys. The kidneys need strong blood flow, but flow diminishes when patients are dehydrated or have low blood pressure. Fever, nausea and diarrhea can lead to dehydration. It’s not uncommon for us to find Covid-19 patients with kidney function so compromised to the point of needing dialysis even if they never end up on a ventilator.

As I always tell my patients, the kidneys suffer along with the rest of the body. Oftentimes, the kidney is kind of an innocent bystander — if the rest of the body isn’t doing well, the kidney feels it, too. Hopefully with mass vaccination, and increasing availability of better and more promising medications, we can do better at continuing to stem the tide against Covid and its effects on our body.