For the first time, an Ebola patient has successfully received dialysis.
It’s typical for patients with Ebola to experience acute kidney injury and kidney failure. It was thought too risky to try dialysis because the large needles and catheters required for the procedure might spread a patient’s highly infectious blood.
The successful procedure will be detailed along with recommended clinical practice guidelines in an upcoming issue of the Journal of the American Society of Nephrology.
Though the researchers wouldn’t say where the patient was from, the patient was described as a healthcare worker from a governmental organization who contracted the virus in Sierra Leone. The patient was transported to Emory University Hospital’s Severe Communicable Disease Isolation Unit in Atlanta for treatment, which included experimental antiviral drugs and intravenous fluids.
According to the report, a diuretic did not work to keep the patient’s kidneys healthy, so doctors began dialysis on the patient’s 11th day sick with Ebola. As the patient’s condition improved, the patient was switched to intermittent dialysis for six to 12 hours a day. Dialysis ended after 24 days total. Doctors found no evidence of Ebola in the patient’s dialysis waste fluids.
Dr. Michael Connor, Jr., and Dr. Harold Franch from the Emory University School of Medicine wrote about the procedure in detail for the journal, discussing the equipment and clinical protocols that resulted in effective dialysis while protecting hospital staff.
"In our opinion, this report confirms that with adequate training, preparation, and adherence to safety protocols, renal replacement therapies can be provided safely and should be considered a viable option to provide advanced supportive care in patients with Ebola," Connor said in a press statement.
Dialysis a Solution, but Perhaps Not for All
"More than anything else, in our report, we found that extra training of our volunteer ICU nurses made success possible," Franch said. "Our case also shows that dialysis is not a death sentence for patients suffering from Ebola virus disease and recovery of kidney function is possible."
Since the patient in the study started dialysis treatment, three others have also had it. Two died and one is still undergoing the procedure, to the best of Franch’s knowledge.
“I think the key is to create a safe environment in the first place and then it becomes like an operating room [as far as rules and procedures go],” Franch said. “Then you just have to adapt your procedures to work in the isolation environment.”
Creating a safe setting to support dialysis may not always be possible in Ebola’s epicenter of West Africa, however, so patients there may not have access to the treatment.
“They’re having trouble just getting basic laboratory tests and IV fluids,” Franch said. Administering IV fluids as well as monitoring salt and electrolyte levels could greatly improve outcomes for patients in West Africa, he added.
Where the Outbreak Stands Now
The World Health Organization (WHO) reported Friday that the death toll from Ebola in Liberia, Guinea, and Sierra Leone was 5,177 out of 14,413 cases diagnosed through Nov. 11.
The president of Liberia said that she would not extend the country’s state of emergency, though a night curfew will stay in effect. In Liberia, the virus has killed more than 2,800 people.
New cases of Ebola are declining Guinea and Liberia, but cases in Sierra Leone are still going up, the WHO reported earlier this month.
On Wednesday, Mali quarantined about 90 people after a nurse at a private clinic in Bamako died from the virus. The nurse was one of three recent deaths linked to Ebola in Mali.
Clinical trials conducted by three different research partners will begin in West Africa in order to find a treatment for Ebola, Doctors Without Borders announced Thursday. The group will test experimental drugs that have not undergone extensive human and animal trials.
Meanwhile, the Ebola panic in the United States seems to have subsided. The outrage, however, isn’t quite over. An estimated 100,000 nurses with National Nurses United protested on Wednesday for better protection for health workers dealing with patients possibly stricken with the deadly Ebola virus.
On Thursday, more than 80 U.S. military members sent to assist with the outbreak in Liberia were set to return home. None are showing signs of infection, but they will be monitored for 21 days at Joint Base Langley-Eustis in southeastern Virginia.
Dr. Martin Salia, an infected surgeon who recently got the virus while treating victims in Sierra Leone, was said to be headed to the Nebraska Medical Center in Omaha, for treatment on Saturday.