As doctors see coronavirus-kidney link, worry grows over dialysis machines
当医生们看到冠状病毒和肾脏之间的联系时，对透析机数量的担忧与日俱增
The novel coronavirus exposes another potential shortage in U.S. healthcare.
新型冠状病毒暴露了美国医疗保健的另一个潜在短缺。
Lucien Bruggeman
吕西安布莱格曼
22 April 2020, 16:00
2020年4月22日16:00
11 min read
11分钟阅读
Jamal Uddin’s coronavirus story began like many others: His health deteriorated, he was hospitalized, he tested positive for COVID-19, and he was treated. Then his health began improving. He was going to be taken off the ventilator -- until his potassium levels spiked.
贾马尔•乌丁(Jamal Uddin)感染冠状病毒的经历和其他许多人一样:他的健康状况恶化，住院治疗，covid19检测呈阳性，并接受了治疗。然后他的健康状况开始好转。他本来要停止呼吸机——直到他体内的钾含量飙升。
A sudden increase in potassium levels, a result of kidney damage, can be treated with a dialysis machine. But at the hospital in hard-hit New York City where Uddin was being treated, his family says every dialysis machine was already in use – a sign, experts say, of the growing connection between COVID-19 and kidney problems.
钾水平的突然升高是肾脏损伤的结果，可以用透析机来治疗。但是在纽约市受灾最严重的一家医院，乌丁的家人说，每一台透析机都已经投入使用了。专家说，这是一个迹象，说明了covid19和肾脏问题之间的联系越来越紧密。
Doctors attempted creative workarounds to treat Uddin – including peritoneal dialysis, which removes fluid through a tube coming from the abdomen – but to no avail. He died within days.
医生们尝试了各种创造性的方法来治疗乌丁，包括通过一根管子从腹部抽走液体的腹膜透析，但都无济于事。几天后他就死了。
Jamal Uddin, 68, passed away last week in a New York City hospital after testing positive for COVID-19, according to his wife, Jesmin. 68岁的贾迈勒乌丁(Jamal Uddin)的妻子杰斯明(Jesmin)说，乌丁上周在纽约市一家医院去世，之前他的COVID-19检测呈阳性。
Jamal Uddin, 68, passed away last week in a New York City hospital after testing positive for COVID-19, according to his wife, Jesmin.68岁的贾迈勒乌丁(Jamal Uddin)的妻子杰斯明(Jesmin)说，乌丁上周在纽约市一家医院去世，之前他的COVID-19检测呈阳性。
Courtesy Shehran Uddin 礼貌Shehran Uddin
“They said that other patients are doing a lot worse than him,” said Uddin’s wife, Jesmin, who recounted his story to ABC News. “Everyone is advertising there are not enough ventilators, that's what I was afraid of -- whether he was going to have a ventilator or not. People are getting better from the ventilator. The lung is getting clearer, but they're not getting dialysis. And that's why people are dying."
“他们说其他病人的情况比他糟糕得多，”乌丁的妻子杰斯明(Jesmin)说，她向美国广播公司新闻频道(ABC News)讲述了他的故事。“每个人都在宣传说没有足够的通风机，这就是我所担心的——不管他是否会有通风机。呼吸机使人们的病情好转了。肺越来越清晰了，但他们没有做透析。这就是人们死亡的原因。”
Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis. 在美国东部时间下午1点和东部时间下午4点收听美国广播公司新闻频道的新冠状病毒特别报道，包括最新的新闻、背景和分析。
The hospital was not able to return ABC News' request for comment because of patient privacy rules, and the Uddin family did not authorize the hospital to speak about his ordeal.
由于患者隐私规定，医院无法回复ABC新闻的置评请求，乌丁的家人也没有授权医院谈论他的遭遇。
MORE: More than 300 US hospitals warn of supply shortages in coronavirus fight, watchdog says 更多:超过300家美国医院发出警告，在与冠状病毒的战斗中，供应短缺，看门狗说
A possible dearth of various life-saving equipment has for weeks nipped at the heels of the novel coronavirus’ spread. But as the disease has begun to appear linked to kidney issues, a new round of ethical questions are being raised about who gets treatment and who doesn’t – and Uddin’s case illustrates fears that otherwise potentially preventable deaths might occur as a result of dialysis equipment shortages.
在新型冠状病毒传播之后的几周内，各种救生设备可能出现的短缺已经对病毒的传播造成了影响。但是，随着这种疾病开始与肾脏问题联系起来，关于谁接受治疗，谁不接受治疗的新一轮伦理问题被提了出来——乌丁的案例说明了人们的担忧，即本来可以避免的死亡可能会因为透析设备短缺而发生。
There's also the question of how to balance the use of dialysis machines for coronavirus patients with the needs of the more than 500,000 Americans with pre-existing kidney disease who already rely on them.
还有一个问题是如何平衡使用透析仪治疗冠状病毒患者和50多万已经患有肾病的美国人的需求。
Guidelines developed at the state level are meant to provide a framework for healthcare providers to prioritize care for certain patients in the event of a crisis that could lead to a scarcity of resources. Critics say some states use broad rules and algorithms -- rather than the on-the-ground opinion of doctors -- that could put patients with chronic kidney disease at risk of not getting the care they need.
在州一级制定的指导方针旨在为卫生保健提供者提供一个框架，以便在发生可能导致资源短缺的危机时优先照顾某些患者。批评人士说，一些州使用广泛的规则和算法，而不是医生的实际意见，这可能会让患有慢性肾病的病人面临得不到他们需要的治疗的风险。
A doctor operates a dialysis machine in an intensive care unit. 医生在重症监护病房操作透析机。
A doctor operates a dialysis machine in an intensive care unit.医生在重症监护病房操作透析机。
Picture Alliance/dpa/picture alliance via Getty I 图片联盟/dpa/通过Getty I图片联盟
Concern among experts is so grave that two leading advocacy organizations for kidney illness penned a letter in recent days to state leaders calling on a shift in policy.
专家们的担忧如此严重，以至于两家主要的肾脏疾病倡导组织近日致信各州领导人，呼吁改变政策。
“A one-size-fits-all category that denies care to all patients with kidney failure is short-sighted, arbitrary, unethical, and discriminatory,” the presidents of the American Society of Nephrology (ASN) and the National Kidney Foundation in a letter to the National Governors Association and the National Conference of State Legislatures wrote last week. Nephrology refers to medical specialization in kidneys.
“放之四海而皆准的类别,否认保健肾衰竭患者都是短视的,任意的,不道德的,和歧视性的,”总统的美国肾脏病学会(ASN)和国家肾脏基金会在一封致全国州长协会和全国各州立法机构会议上周写道。肾脏学是指肾脏的医学特化。
“Blanket policies that categorically restrict the access of kidney patients, and other vulnerable populations, to critical care are scientifically unfounded and inappropriately interfere with the trusted patient-physician relationship as well as disregard basic principles of medical ethics,” the groups added. “Unilateral guidance should never outweigh sound, individualized medical judgment.”
这些组织还说:“那些明确限制肾病患者和其他弱势群体接受重症监护的一揽子政策是没有科学依据的，而且不恰当地干扰了值得信任的医患关系，并且无视医学伦理的基本原则。”“单方面的指导永远不应该超过合理的、个性化的医疗判断。”
MORE: Doctors fear shortage of drug critical to ventilator treatment for coronavirus 更多:医生担心呼吸机治疗冠状病毒的关键药物短缺
An estimated 40 million adults in the U.S. have chronic kidney disease, according to the Centers for Disease Control and Prevention (CDC). Experts anticipate even more Americans will develop kidney ailments as a result of the coronavirus pandemic, but the extent of the kidney damage in confirmed coronavirus patients remains unclear.
据美国疾病控制与预防中心(CDC)估计，美国约有4000万成年人患有慢性肾病。专家预计，由于冠状病毒大流行，更多的美国人将患上肾病，但确诊的冠状病毒患者的肾脏损害程度仍不清楚。
The ASN and U.S. Department of Health and Human Services (HHS) are “working to get better numbers – harder numbers – than the impressions of nephrologists,” according to Dr. Alan Kliger, a Yale nephrologist and co-chairman of the ASN coronavirus task force.
爱生公司和美国卫生与公众服务部(HHS)正在“努力获得更好的数字——更准确的数字——而不是肾病学家的印象，”耶鲁大学肾病学家、爱生冠状病毒工作组联合主席阿兰·克里格博士说。
Medics and hospital workers prepare to lift a COVID-19 patient onto a hospital stretcher outside the Montefiore Medical Center... 医务人员和医院工作人员准备将一名covid19患者抬上医院的担架，该担架位于Montefiore医疗中心外。
more更多的
Medics and hospital workers prepare to lift a COVID-19 patient onto a hospital stretcher outside the Montefiore Medical Center Moses Campus on April 07, 2020, in the Bronx borough of New York.2020年4月7日，纽约布朗克斯区，医务人员和医院工作人员准备将一名covid19患者抬上医院的担架。
John Moore/Getty Images 约翰摩尔/盖蒂图片社
What is clear, experts say, is that a substantial proportion of critically ill coronavirus patients – those on ventilators in the intensive care unit – require dialysis machines. The number of those needing dialysis range from 20-40% of that severely ill subgroup of positive cases, according to Kliger.
专家们说，有一点是清楚的，在重症监护病房使用呼吸机的重症患者中，有相当比例的冠状病毒患者需要透析机。Kliger说，需要透析治疗的人数在20-40%的重症阳性者亚组中。
Studies and clinical anecdotes indicate that the coronavirus can attack the kidneys, leading to kidney failure or, in patients with existing kidney disease, exacerbate matters. Compounding the issue is that kidney disease is made worse in patients who require mechanical ventilation, like many patients with severe cases of the coronavirus. Without dialysis, fluid can accumulate in the lung when the kidneys can't remove enough fluid and toxins from the body.
研究和临床趣闻表明，冠状病毒可攻击肾脏，导致肾功能衰竭，或使已有肾脏疾病的患者病情恶化。更糟糕的是，需要机械通气的患者的肾脏疾病会恶化，就像许多冠状病毒重症患者一样。如果没有透析，当肾脏不能从体内排出足够的液体和毒素时，液体就会在肺部积聚。
MORE: Lawsuit filed against WHO over its handling of coronavirus outbreak 更多:对世界卫生组织处理冠状病毒爆发的诉讼
“These patients generate the toxins that are removed by dialysis at a phenomenal rate – a rate that will make your eyes pop out,” said Dr. Joel Topf, the medical director of St. Clair Nephrology Research in Detroit, Michigan. “We are finding we need to dialyze these patients every day using high doses of the dialysis to clear off these toxins … and that really adds to the stress on resources.”
密歇根州底特律市圣克莱尔肾病研究中心的医学主任乔尔·托普夫博士说:“这些病人体内产生的毒素会以惊人的速度通过透析排出体外——这种速度会让你的眼睛突出来。”“我们发现，我们需要每天对这些患者进行高剂量透析，以清除这些毒素……这确实增加了对资源的压力。”
Experts cited a growing need for both dialysis machines and the fluid required to dialyze patients. Because manufacturing new machines can be an arduous process, Dr. Sunny Jha, a USC anesthesiologist, suggested states with fewer cases donate machines to the “hot spots” – not unlike the reallocation of ventilators in recent weeks.
专家指出，对透析机和透析液的需求越来越大。由于制造新机器可能是一个艰难的过程，南加州大学麻醉学家Sunny Jha博士建议病例较少的州捐赠机器给“热点地区”——这与最近几周呼吸器的重新分配没有什么不同。
“We have had trouble getting the fluids needed for dialysis. Machines are needed as well but getting them can be complicated,” said Dr. Jha. “One way that we can address this is by asking those not seeing as much kidney disease and coronavirus to reallocate their supplies to the hot spots.”
“我们在获得透析所需的液体方面遇到了麻烦。机器也是需要的，但获得它们可能是复杂的，”Jha博士说。“我们可以解决这个问题的一个方法是，让那些没有那么多肾病和冠状病毒的人重新分配他们的供应到热点地区。”
STOCK PHOTO: Hemodialysis machines with tubing and installations. 库存照片:血液透析机与管道和安装。
STOCK PHOTO: Hemodialysis machines with tubing and installations.库存照片:血液透析机与管道和安装。
STOCK PHOTO/Getty Images 股票照片/盖蒂图片社
The creative spirit hospitals are exercising to preserve resources extends beyond supplies, experts suggest. Staffing shortages – nurses and dialysis machine technicians – are also being stretched thin.
专家建议，创新精神医院正在努力保护供应以外的资源。人员短缺——护士和透析机技术人员——也在不断减少。
“Physicians are having to be creative in these circumstances and other types of dialysis machines require specifically trained dialysis nurses which are hard to find,” said Dr. Nwamaka Eneanya, Nephrologist and Assistant Professor of Medicine at the University of Pennsylvania.
宾夕法尼亚大学(University of Pennsylvania)肾病学家、医学助理教授Nwamaka Eneanya博士说:“在这种情况下，医生必须发挥创造力，而其他类型的透析机需要经过专门培训的透析护士，而这是很难找到的。”
MORE: The coronavirus dilemma: Are we using ventilators too much? 更多:冠状病毒困境:我们是不是用了太多的呼吸器?
Topf echoed that sentiment, noting that the coronavirus “is just wearing down the nurses, and we are really asking a lot of them.”
Topf也表达了同样的观点，指出冠状病毒“正在让护士们疲惫不堪，我们真的问了他们很多问题。”
“If you focus on machines and fluids and filters, you’re not talking about the real story,” Topf added. “The real story is people.”
“如果你关注的是机器、液体和过滤器，你谈论的不是真实的故事，”Topf补充说。“真正的故事是人。”
Taken together, the strain on resources – both human and logistical – remains a threat to those at risk of contracting kidney ailments. And with guidelines in place in some states that might push those resources out of reach of those on dialysis, nephrologists and medical experts hope to spread awareness of the risks.
综上所述，人力和后勤资源的紧张对那些有患肾病风险的人来说仍然是一个威胁。随着一些州出台的指导方针可能会使这些资源超出透析患者的承受能力，肾病学家和医学专家希望能传播对这些风险的认识。
“Given the discussions we have been having about using ventilators and crisis standards of care, as well as scare resource allocation, it might be time to start tracking the use of dialysis treatment in critical care and if we have the skilled nurses we need to deliver care to patients with kidney failure,” said Dr. Kelly Michelson, director of the Center for Bioethics and Medical Humanities at Northwestern University. “This can help us get in front of the issue and provide insight to help inform ethics conversations.”
“鉴于我们一直在讨论使用呼吸器和危机的护理标准,以及恐慌资源分配,它可能是时候开始跟踪使用透析治疗在重症监护和如果我们有我们需要的技能的护士提供护理患者肾衰竭,”凯利迈克耳逊博士说,中心主任生物伦理学和医学人文在西北大学。“这可以帮助我们站在这个问题的前沿，为道德对话提供洞见。”
