The leading cause of end-stage kidney disease (ESKD), also known as kidney failure, is diabetes.1 This is because poorly controlled diabetes can result in damage to blood vessels in the kidney over time. The damage leads to scarring, which reduces the filtration capacity of the kidney, progressing to ESKD. In 2018, the United States reported 395 cases of ESKD per million population, and diabetes was the cause in almost half of those cases.2
New studies have shown that there are potential pathways between COVID-19 and new-onset diabetes.3 In patients with COVID-19, it is noted that an increase in inflammatory markers can cause a persistently high level of glucose which may lead to insulin resistance. Steroids are also the first line treatment for COVID-19, which are also known to contribute to insulin resistance. If this persists, patients can develop type 2 diabetes. At the Children’s National Hospital in Washington, DC, there was a 182% increase in new cases of type 2 diabetes in the first year of the COVID-19 pandemic compared to the previous year.4 This is a cause for concern because a rise in diabetes incidence can lead to a rise in ESKD cases.
The emergence of the COVID-19 pandemic has also complicated the lives and treatment of those with ESKD. There are two treatment options for ESKD: dialysis and kidney transplantation. For patients with ESKD and diabetes, kidney transplantation as treatment has a better survival rate than dialysis. Still, unfortunately, the need for kidney transplantation is greater than the number of organs available.5,6 A recent study focusing on organ procurement and transplantation in France and the US during the COVID-19 pandemic shows that there is a drastic decrease in organ procurement and transplantation in both countries.7
With fewer organs available for transplantation, patients stay on the waiting list longer. Throughout this time, they have to be on dialysis. Patients on dialysis have poorer outcomes if they contract the virus as they have a 20% or higher chance of mortality.8 Patients with ESKD usually have other comorbidities that make them even more vulnerable to COVID-19. These individuals risk their lives every time they enter a dialysis building, typically at least three times per week. The COVID-19 pandemic also complicates receiving in-unit dialysis, as patients with ESKD are at high risk of developing severe complications if they contract the virus, and it is difficult to provide adequate social distancing between patients.9
At-home dialysis would greatly enhance those with kidney disease to physically distance for safety and would be a better alternative to in-unit dialysis. Going further, kidney transplantation would preclude the need for dialysis. However, the lack of kidney donors and the cost of at-home dialysis still pose barriers.9,10 Policies that provide adequate insurance coverage for at-home dialysis including coverage for staff assistance would also help this vulnerable population with ESKD. In addition, aggressive targeted outreach efforts such as television and social media campaigns can help educate the population about organ donation, improving the consent rate. Evidence-based policies and effective education can improve the lives of those with ESKD as the COVID-19 pandemic further endangers their wellbeing.
Aliyah Patterson is a second-year medical student at Loma Linda University School of Medicine. She graduated from the University of the District of Columbia with a degree in Biology in 2020 and spent most of her time there conducting cancer research. Her newly found passion is in improving organ donation and transplantation, especially in developing countries.