More Federal Help Is Needed to Address COVID-19 Crisis Facing Kidney Patients

In times of crisis, Americans always find a way to answer the call. The COVID-19 emergency, although unique to history, is no different. 

We are taking necessary precautions, maintaining social distance and helping our neighbors. We are following the science, observing guidelines and working together to flatten the curve — with the hope of saving lives and putting this deadly virus behind us. 

But there’s another layer of action desperately needed to help protect some of the most vulnerable Americans among us. It falls to our lawmakers and policymakers to answer the call and act. 

Many of the more than 37 million Americans living with chronic kidney disease and kidney failure, known as end-stage renal disease, don’t have any choice but to venture out into community health care settings. The nearly 500,000 of those individuals receiving in-center dialysis can’t “socially distance” and stay home because their lives depend on routine dialysis care three times a week for several hours at a time. 

The frontline caregivers who make this treatment possible can’t stay home, either, as they are essential to provide care during dialysis. Under these very demanding and emotional circumstances, caregivers are working tirelessly to stem the transmission of COVID-19 while ensuring essential patient care isn’t compromised. 

We know, based on data from China, Italy and Washington state, that individuals with CKD and ESRD may face higher morbidity and mortality rates from COVID-19 than the general population due to multiple disease conditions and immune deficiencies. So, dialysis and health care providers have increased patient screening and evaluation, recommending isolation and separation of sick patients and clinical staff to avoid contagion spread. 

Dialysis centers are also implementing additional shifts to accommodate evolving patient needs. These protocols are necessary, and they all require increased staffing and resources.

We applaud Congress and the administration for acting quickly to provide additional resources for personal protective equipment and additional assistance to dialysis providers through the $100 billion provider fund and other resources to help manage the unique challenges of COVID-19. In addition, we appreciate the multiple policies that the administration has revised, as well, to reduce barriers to providing treatment to infected patients, such as expanding access to telehealth services to reduce exposure risks and eliminating other burdensome rules that were making it difficult to provide treatment to patients who are infected with the virus. The leadership of policymakers and their actions will help ensure that dialysis patients will continue to have access to their lifesaving treatments while minimizing the risk of infection.  

However, more can be done to minimize risk to this patient population. In a recent letter to Capitol Hill and the Centers for Medicare and Medicaid Services, KCP called on Congress and the administration to take a number of other actions in response to the crisis. Most important among these asks are the following:

— Clarifying that isolation due to COVID-19 positive or suspected COVID-19 positive status meets medical necessity for non-emergency ground ambulance transports.

— Allowing providers to provide financial assistance to patients for transportation, food, and other necessities during the crisis.

— Covering and reimbursing for PD home dialysis for acute kidney injury patients instead of requiring them to have a new catheter placed in order to receive in-center dialysis.

— Providing coverage under Medicare Part D for oral agents indicated by the Food and Drug Administration to treat conditions associated with CKD in patients during the pandemic to eliminate the need for these patients to risk exposure by having to go to infusion treatments in hospital outpatient departments.

CKD and ESRD are incredibly complex diseases, and the interventions needed to keep our patients healthy are no less so. Americans living with these conditions are already seeing an interruption in transportation and nutrition services. Congress and the administration can alleviate these problems by passing legislation and issuing regulatory guidance supported by the kidney community.  

When we look back on this global crisis decades from now, more than anything, it will certainly be with pride for our health care heroes who saved lives and cared for not only those sick with COVID-19 but also our most at-risk citizens in need of continuing care. 


John Butler is CEO of Akebia Therapeutics and the new chair of Kidney Care Partners, the nation’s leading kidney care coalition composed of patient advocates, dialysis professionals, care providers, researchers and manufacturers dedicated to working together to improve quality of care for individuals living with kidney disease, kidney failure and transplants.

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