Safe, Successful Kidney Dialysis Possible in Ebola Patients

Emory doctors report on successful and safe protocol

Friday, November 14, 2014

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FRIDAY, Nov. 14, 2014 (HealthDay News) -- U.S. doctors say they now have a protocol for safely and effectively providing dialysis to Ebola patients who have kidney failure.

Doctors at Emory University in Atlanta described the first successful dialysis of an Ebola patient -- a patient who not only survived the infection, but recovered normal kidney function.

Just as important, experts said, none of the health care workers involved in that patient's care contracted the virus.

"To me, this helps demystify this disease," said Dr. Michael Connor, an assistant professor of medicine and one of the Emory doctors reporting on the dialysis success. "With the appropriate supportive care, this is a beatable disease for the majority of patients treated in a resource-rich [country]."

Emory University has treated four of the nine recent U.S. Ebola patients -- all of whom survived, with the exception of Thomas Eric Duncan, according to published reports. Duncan, a Liberian man who traveled to Dallas in September, had a delay between his first symptoms and treatment.

The Emory team reported its dialysis protocol Friday at the annual meeting of the American Society of Nephrology (ASN), in Philadelphia. It will also be published online Nov. 14 in the Journal of the American Society of Nephrology.

Sudden kidney failure is common in critically ill patients, and it's believed to be common in those with Ebola -- though no one knows the exact numbers, according to background information in the study. In Africa, Connor said, it's hard to get a handle on the prevalence, because the lab tests used to diagnose kidney failure simply aren't available.

When acute kidney damage becomes severe enough, patients need dialysis -- where a machine takes over some of the kidneys' vital work. The process helps clear the blood of excess water, salt and waste products, according to the National Kidney Foundation.

But dialysis involves large needles, catheters and possible contact with patients' blood -- which puts health care workers at risk. Plus, it's been thought that when Ebola patients get so sick that they need dialysis, they're likely to die anyway, according to the study.

But the Emory patient proves that the need for dialysis is "not a death sentence" for Ebola patients, said Dr. Harold Franch, one of Connor's colleagues, and an assistant professor of medicine at Emory.

With careful training and the right precautions, patients can recover and health care workers can be kept safe, according to Franch. One of the safety measures is to have only "extensively trained" ICU nurses take care of the dialysis in the isolation unit, and limit other staff members' time there.

Franch said the extra training given to the ICU nurses -- all volunteers -- was key in this case.

"We can't thank them enough for their hard work -- and for keeping themselves safe, which also keeps the community safe," Franch said.

The patient was a health care worker who'd contracted Ebola in Sierra Leone -- one of three African nations bearing the brunt of the current outbreak. As of Nov. 9, nearly 14,100 people worldwide have been diagnosed with Ebola, and 5,160 have died, according to the U.S. Centers for Disease Control and Prevention (CDC).

"This patient was critically ill, but with excellent care was able to leave the hospital," said Dr. Sarah Faubel, a kidney disease specialist at the University of Colorado Denver School of Medicine.

"You really can't say enough about the Emory team, and how thoughtful their approach was to maintaining the safety of the patient, the health care workers and the community," said Faubel, who also chairs the ASN's acute kidney injury advisory group.

Any potential risk to the public would be "very low," Faubel noted. But the Emory team took the step of testing the "effluent" (basically, urine) produced during the patient's dialysis; there was no evidence of Ebola genetic material -- which means it was not infectious.

Franch called that finding "reassuring," though the effluent was still disposed of as hazardous waste because it came from an Ebola-positive isolation unit.

The Emory protocol is being shared with other hospitals that treat Ebola patients, Connor said.

The journal report will be free online, he noted, and the CDC used the case in developing its new guidelines on dialysis for Ebola patients.

SOURCES: Michael Connor, Jr., M.D., assistant professor, medicine, Emory University, Atlanta; Harold Franch, M.D., assistant professor, medicine, Emory University; Sarah Faubel, M.D., associate professor, medicine, University of Colorado Denver School of Medicine; Nov. 14, 2014, Journal of the American Society of Nephrology, online; Nov. 14, 2014 presentation, American Society of Nephrology meeting, Philadelphia

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