April 3, 2020, New York, NY — 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 judgment, 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.”
The National Kidney Foundation is advocating for efforts to accelerate the manufacture and distribution of critical medical supplies, including ventilators. However, as health systems find themselves without adequate supplies, we encourage these groups to adapt decision-making protocols that treat each patient as an individual and determine treatment plans that reflect each patient’s unique medical circumstances. Unilateral guidance should never outweigh sound, medical judgment.
This position is supported by the U.S. Department of Health and Human Services’ Office of Civil Rights, which stated last week that, “[d]ecisions … concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient and his or her circumstances, based on the best available objective medical evidence.”
Find more information and resources on kidney disease and COVID-19 on the NKF resource page www.kidney.org/coronavirus.
Kidney Disease Facts
In the United States, 37 million adults are estimated to have chronic kidney disease—and more than 90 percent are unaware they have it. 1 in 3 American adults are at risk for chronic kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end-stage renal disease (kidney failure).
About the National Kidney Foundation
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.