“Whoever will need dialysis, does it intubated. We know that 5% of patients have severe forms, which need to intubate. When the condition is very severe, the patient may have kidney damage and need hemodialysis because the kidney stops working,” he says Osvaldo Merege, president of SBN.
According to Merege, this situation affects up to half of critically ill patients. “In percentage, of the 5% that are intubated, 2.5% are in need. We have cases of hospitals undergoing dialysis in 30%, 40% and even half of the intubated patients.”
Organ damage can be caused by a serious event that affects some people with covid-19, the storm of cytokines, an exacerbated reaction of the immune system that can affect the functioning of vital organs and lead to death. Sepsis and the action of the virus on the organ can also be linked to the cases.
In late March last year, intensive care pediatrician Nelson Horigoshi, 65, had a covid-19 after going to a family meeting.
“One person was infected. Six people got it and I was the only one in the hospital. And I was in a serious condition. I was intubated for ten days and had to do some hemodialysis sessions. When my kidney started to respond, I managed to get rid of it. In all, they were 20 days in the ICU and 20 days in the bedroom. ”
In addition to the kidney problem, Horigoshi had cardiac and pulmonary involvement. “The cardiac part was the one that reversed the fastest. The lung took three months to normalize, but I still have a little fatigue to this day. I have insomnia and the kidney took a long time to improve. This month was the first that I had the kidney exam with result normal. It’s a terrible disease. ”
According to the president of SBN, some patients recover, but there are cases of people who end up progressing to chronic kidney disease. However, there is still no record of overload in the service because of the arrival of people who overcame the covid-19 and had sequelae in the kidneys.
“It has no impact on the chronic ones, because they are machines used for acute cases. In chronic kidney patients, dialysis is programmed. But the number of acute cases has increased a lot in this new variant and with severe cases even among the youngest.”
Merege says that there are currently 144,500 chronic kidney patients on dialysis and that covid-19 is dangerous for this group. “In the general population, mortality from covid is 2.3%. In the population on dialysis, 30% of those who get covid end up dying. Therefore, it would be important to prioritize the vaccine for these patients.”
HCor Nephrology medical leader, Leda Lotaif, says that the hospital increased the number of equipment already last year because she noticed that there were cases of kidney failure reported by other countries. There were eight pieces of equipment, went to ten, reached 15 and should receive four more in the next few days. With the P1 variant, there is a perception that cases started to occur more frequently.
“We have not sequenced these patients, but at P1, apparently, it is a more serious disease, which evolves quickly and gives more kidney failure. We had an increase in patients in need of dialysis and there are more young patients, in their 30s and 50s. . It is definitely a more serious strain. ”
At the hospital, according to Leda, between 35% and 40% of patients in the ICU need to do the procedure.
“We have patients who have already been discharged and patients who have had sequelae in the kidney and will have to follow up with a nephrologist. The kidneys are vital organs and people are not so aware until the moment when someone in the family starts to have kidney failure. They maintain fluid balance, are important for bone health and produce hormones that stimulate the bone marrow to produce red blood cells. People should spare themselves from having a disease like that. ”
Entity says end of exemption from ICMS damages centers in SP
The Brazilian Association of Dialysis and Transplantation Centers (ABCDT) says that the units that perform dialysis were hampered by the tax reform carried out by the state management, which removed the exemption from the Tax on Circulation of Goods and Services (ICMS) for medicines and supplies.
“We showed that, as of January 1, this decree that returned to charge ICMS from various sectors would impact the dialysis sector. Most clinics are private, but serve SUS patients. When there is an increase in the tax, it is passed on to dialysis clinic “, says nephrologist Marcos Alexandre Vieira, president of ABCDT.
According to him, the sector has already been suffering from increases during the pandemic. “These are high-tech drugs, there are solutions to filter blood and machinery. Just due to the increase in the dollar, there is an increase in the price of products and will still have an 18% tax.” Vieira says the organization is trying to meet with the government to debate and try to reverse the situation.
In a note, the State Secretariat of Finance informed that patients treated by SUS will not be impacted by the measure.
“In the State of São Paulo, the standard ICMS rate is 18% and the lower rates are tax incentives, as provided for in the Fiscal Responsibility Law. The entities that represent the private health sector were received at meetings and heard by the government in the It was explained in a clear and objective way that the government’s priority, in this pandemic moment, is to guarantee free care to the most needy population, both in health and in other essential services, such as education, public security and social assistance. . It is important to remember that the fiscal adjustment is temporary, valid for 24 months. ”
How does covid-19 affect the kidneys?
Kidney damage may be caused by the cytokine storm, according to Leda Lotaif, HCor’s nephrology medical leader. “That is, inflammatory mediators released in great concentration in the blood circulation causing renal inflammation, as well as causing pulmonary, cardiac and other organs inflammation;
“This is a” cross line “of the lung-kidney axis, in which the acute respiratory syndrome caused by the covid causes kidney damage”, explains Leda;
Systemic effects caused by sepsis, a serious infection that can affect the functioning of organs and lead to death;
Cases of direct damage to kidney cells by the new coronavirus.
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