Dialysis machines are used to remove waste products and excess fluid from the blood when the kidneys stop working properly. The treatment, known as hemofiltration, is a delicate process which mimics the kidney, by continually cleaning the blood of toxins and rebalancing it with, for example, electrolytes. The technique requires a very specific range of kit and fluids to work.
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.
The Department of Health has issued a supply disruption alert stating that the clinical presentation of Covid-19 patients admitted to critical care suggests that there is a higher than usual demand for Renal Replacement Therapy (RRT) in patients where viral disease is the reason for admission. Intensive Care National Audit and Research Centre (ICNARC) are reporting that 28.8% of patients requiring advanced respiratory support also require RRT (17th April 2020 ICNARC)
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. The government says a recent surge in demand is to blame, with almost 30% of patients with Covid-19 on ventilators require this type of treatment, the latest UK data suggests.
The 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, have all reported dwindling supplies of the hemofiltration kits and fluids, according to a supply distribution alert from the Department of Health and Social Care.
Doctors are saying they face the prospect of rationing dialysis amid a shortage of equipment to treat a quarter of the sickest coronavirus patients. During the pandemic, more seriously ill patients are experiencing blood clots which are causing the machines filters to become clogged up and stop working after a few hours instead of several days.
The government's alert to the NHS lists more than 40 different fluids and parts of kit used regularly in life-saving kidney support as being in short supply. The Faculty of Intensive Care Medicine said the problem was adding to the stress of the situation during the coronavirus epidemic, and that in terms of supply they were "living hand to mouth".
Trusts are being asked to minimise use wherever possible and for those which don't need supplies, to offer them to other parts of the NHS who are in need. "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," as spokesman for the Department for Health and Social Care said. "Guidance has been provided to clinical teams to support them in maintaining provision of dialysis treatment."