Dialysis patients may have been the “perfect victims” of the pandemic. For the first time since the United States has kept track of its numbers, the nation’s dialysis population has shrunk. Between safety concerns at dialysis facilities and the unfortunate way COVID-19 treats those with weakened immune systems, patients are struggling now more than ever. 

Who is Cheryl Cosey?

A 58-year-old native of Chicago, Illinois, Cheryl Cosey has been on both sides of dialysis care. For years, she worked as a technician, where she provided care to patients and set up dialysis machines for treatment. Now, she is a dialysis patient herself and, during the pandemic, took a transport van three days a week to her dialysis facility. 

In the pandemic’s first few weeks, Cosey was diagnosed with COVID-19 and turned away from her regular dialysis facility. As a dialysis patient with a weakened immune system, Cosey feared for her health with COVID-19 and without dialysis. After four days with no dialysis treatment, a facility designed for suspected or diagnosed COVID-19 patients found a time for her treatment. 

After Cosey’s first treatment at the new facility, her daughter, Shardae Lovelady, picked her up, only to discover Cosey disoriented and struggling to breathe. Due to the facility’s safety protocols, Lovelady was not assisted outside of the facility and had to get her ill mother into the car by herself. 

Lovelady recalls, “They offered no assistance. They treated her as though she was an infection.” 

In the facility’s parking lot, Lovelady called 911 and had her mother transferred to a hospital. Cosey made it to the hospital but sadly passed away days later from the virus. 

How Is the Pandemic Worse for Dialysis Patients?

Cosey’s experience with COVID-19 and incenter dialysis is similar to many others. Along with stressful facility experiences, it is estimated that nearly 18,000 more dialysis patients died in 2020 than would have been expected based on previous years. The death rate of dialysis patients in 2020 was nearly 20% higher than in 2019. 

“It can’t help but feel like a massive failure when we have such a catastrophic loss of patients,” said Dr. Michael Heung, a clinical professor of nephrology at the University of Michigan. “It speaks to just how bad this pandemic has been and how bad this disease is.”

There are many reasons why the death total is high:

• A severely weakened immune system from advanced kidney disease and other conditions leaves some patients powerless to fight dangerous infections.
• With many dialysis patients receiving treatment at incenter facilities, they must leave the safety of their home and travel to facilities where they can face additional exposure.
• Many incenter dialysis facilities set safety protocols in the pandemic’s early days but did not follow their policies, such as wearing a face mask and washing hands.
• Some patients skip important doctors’ appointments or delay going to the hospital when feeling ill due to fear of the virus.
• Most dialysis patients are either Black or Hispanic and have faced comparative access barriers during the pandemic. They are less likely to be placed on the transplant list or be offered other dialysis modalities than white patients. 

What Can Be Done? 

CMS hopes to address the concerns by encouraging eligible patients to pursue home dialysis and financially incentivizing dialysis companies to offer it. Currently, there are two home dialysis options: peritoneal dialysis (PD) and home hemodialysis (HHD). Each of these options has its pros and cons, but they both have the potential to be as effective and safer than incenter dialysis. 

If you or a loved one are not familiar with home dialysis, talk to your doctor and healthcare team to see how it may benefit you. Many patients may think it will be too much work or stress, but each patient receives weeks of training and has an on-call nurse available. 

*ProPublica. (2022, January 13). They Were the Pandemic’s Perfect Victims. https://www.propublica.org/article/they-were-the-pandemics-perfect-victims