Hospitals Urged to Avoid Policies to Omit Kidney Patients from Ventilator Use

In a letter sent to the leading trade organizations representing the nation’s hospitals and health systems, the National Kidney Foundation (NKF) expressed concern over news reports that some health systems and state governments are considering crisis-management policies which would deprive certain patient groups—including patients with end stage renal disease—of life-saving interventions for COVID-19, including ventilation. The National Kidney Foundation understands that these are extreme circumstances but cannot support a policy that would arbitrarily deny someone treatment due to their pre-existing health condition or disability.
“As a nephrologist who treats end stage renal disease patients, I can tell you that each patient is different and medical judgement, instead of arbitrary hospital or health system guidelines, should be used when determining who gets access to a life-saving ventilator and other COVID-19 treatments,” said Holly Kramer, MD, President of National Kidney Foundation and a board certified nephrologist. “Thanks to the miracles of dialysis and transplant, end-stage renal disease is not a terminal condition and should not be treated as such.”
Dialysis serves as an artificial kidney for patients with end-stage renal disease. Dialysis machines remove waste and extra chemicals and fluid from the blood, help maintain the body’s natural chemical levels, and help control blood pressure.  Currently, more than 500,000 Americans rely on dialysis to replace their kidney function.  Average life expectancy on dialysis is 5-10 years, however, many patients live well on dialysis for 20 or even 30 years. For many patients, dialysis is a temporary treatment as they await a kidney from a deceased or living donor.
“While we appreciate that these draft policies attempt to set parameters to help health care providers make unimaginable, heartbreaking choices, a one-size-fits-all category that denies care to all patients with ESRD is short-sighted, arbitrary and discriminatory,” said Kevin Longino, CEO of National Kidney Foundation and a kidney transplant patient. “Such policies could deny care to entire categories of individuals who might recover from COVID-19 and go on to live long, productive lives.”
These concerns are echoed in recent articles in the Journal of the American Medical Association, which states that “These [categorical] exclusions are not explicitly justified, and they are ethically flawed because the criteria for exclusion (long-term prognosis and functional status) are selectively applied to only some types of patients, rather than to all patients being considered for critical care.”
https://www.biospace.com/article/releases/national-kidney-foundation-urges-america-s-hospitals-and-health-systems-to-not-implement-polices-to-deprive-kidney-patients-from-live-saving-interventions-during-covid-19/