Hospitals running out of kidney dialysis equipment needed to keep coronavirus patients alive

Hospitals are running out of vital kidney dialysis blood filtering kits that are needed to keep up to a third of Covid-19 patients alive in another NHS shortage that threatens to compromise coronavirus care.

Doctors told The Independent they were already under pressure to use equipment conservatively and choices were needing to be made about which patients should receive the treatment, without which they would likely die within 24 hours.

Because of the complications caused by coronavirus, special filters used to remove toxins from the blood that normally last for up to 72 hours are becoming unusable after just three hours, leading to a spike in demand. NHS England has now taken control of the national supply of the main kits with hospitals instructed to share any spare equipment with their neighbours.

The issues comes after criticism of the government over lack of ventilators for coronavirus patients, while protective equipment including masks and gowns to keep staff safe has also been in short supply.

One consultant said supplies were now "just-in-time" addiing: "We are being asked to guess how many sets we will need four days in advance and bits of kit are being ferried between hospitals in taxis where those predictions aren't known. Clinically, for renal failure as part of critical illness we usually deliver filtration continuously. Because of shortages of kit and machines we are having to deliver it on an intermittent basis which is suboptimal.

"For context, we have one machine per two ICU patients normally, but now have the same four machines for over four times the number of beds."

Around a third of coronavirus patients in intensive care develop severe problems with their kidneys and need their blood artificially filtered. An intensive care doctor from a central London teaching hospital said decisions had already been made there to conserve filtration for patients who were likely to survive, with at least one patient taken off dialysis “as a resource conservation measure”.

The doctor told The Independent: “The risk is definitely there and if we don’t make these decisions at this point then we could have someone who needs filtration and would probably survive and we would not be able to do it.”

The doctor said coronavirus patients seemed to have a particular problem with blood clots and, despite taking anticoagulant drugs, many still developed clots in their lungs, kidneys and even their brain. During dialysis filtration any clot means the filter and system has to be replaced.

Another intensive care doctor in the north of England said the supply of haemofiltration kits was likely to be the next equipment shortage scandal to hit the NHS.

He said: “We’ve been told that NHS England is taking over the supply chain and deciding who gets what. With Covid-19 patients clotting lines and going through filter sets faster than normal, there’s a concern that demand is going to outstrip supply.”

In an alert to hospitals this week NHS England said the three main suppliers of 70 per cent of the kits used by the NHS were reporting “limited supplies of haemofiltration sets and fluids in the system”.

It added: “The current supply issues are due to the recent increase in demand during the Covid-19 pandemic. 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.”

It explained that Covid-19 patients are clotting both filters used to remove toxins from the blood and the lines taking the patient’s blood to the machine.

It added: “The manufacturers measure usual filter life as approximately 72 hours, whereas filters can become clotted after several hours of use. This has led to a global excessive demand for consumables.”

Hospitals have been told to share their equipment with neighbouring hospitals if they are running out and to use the machines and filters conservatively.

Concerns have been growing since the start of April when NHS England carried out a nationwide stocktake of equipment in the country as it became clear a large number of Covid-19 patients were suffering what is called an acute kidney injury and needed dialysis.

A letter sent to critical care managers on 12 April warned hospitals to use kits intermittently rather than continuously to maximise their usage. On Tuesday NHS England wrote again to critical care managers saying the national picture was being reviewed daily and gave advice on how hospitals should care for patients needing renal replacement therapy.

NHS England has now taken control of the supply chain for the kits and is identifying where they need to go based on a daily review of data submitted by hospitals.

An NHS England spokesperson said: “There is significant global pressure on the supplies of the particular types of renal replacement therapies being used to treat Covid-19 patients who develop kidney problems, and the NHS is working with government and our partners to ensure supplies are maintained.”