Doctors' First Success in Ebola Dialysis

By Lydia O'Neal Senior Staff Writer

Doctors at the Emory University School of Medicine recently released a study on their successful use of dialysis as a life-supporting treatment for a patient at Emory University Hospital infected with the Ebola virus – the first known successful use of such treatment.

The study's two lead authors, Dr. Michael Connor and Dr. Harold Franch, presented their findings to the American Society of Nephrology (ASN) in Philadelphia and published the study online on Friday, Nov. 14. The Journal of the American Society of Nephrology will feature the findings in its Nov. 25 issue.

"Whether someone did it in the 1990s and didn't write about it, we don't know, but so far as we know, we were first," Connor, an assistant professor of medicine, said of the dialysis treatment for Ebola patients.

The patient receiving dialysis, who was not identified, was the third Ebola patient cared for in the Hospital's isolation unit, following surviving missionaries Dr. Kent Brantly and Nancy Writebol, who arrived about a month earlier. The patient arrived at Emory University Hospital on Sept. 9 from Sierra Leone after four days of showing symptoms, according to Franch, who is also an assistant professor of medicine.

Four days after the third patient's arrival, Franch said, "his kidneys weren't working so well."

The patient suffered from acute kidney injury, a common complication of Ebola due to the dehydration caused by the sufferers' frequent vomiting and diarrhea, according to Connor. The hemodialysis machine, used not as a treatment for the virus, but as a life-support mechanism, acted as an artificial kidney to prevent renal failure by filtering out waste that would normally exit the patient through urinating, Connor said.

"Providing dialysis is not a treatment specifically for Ebola – it is a form of life support," Connor said. "It allows them to stay alive long enough to see if their body can get rid of the virus."

About half of Ebola patients suffer from acute kidney injury during intensive care unit admission, Connor said, and about five to 10 percent of them require dialysis.

The procedure, however, had many safety implications, with one of the biggest concerns being the size of the catheters used to transport the patient's blood through the filter and back into his or her body.

Patients may be confused and could potentially pull out the IVs, according to the study's co-author Dr. Colleen Kraft, who was one of seven doctors caring for the patient.

Another worry, Connor said, was the case of an emergency.

"We had to come up with stringent protocols to not only protect health care workers, but also the patient," he said. "In the biocontainment ward, you can't just rush in to help the patient – you have to put on all of the personal protective equipment on first. So we had a nurse prepared for any emergency in the room with the patient at all times."

Thirty-five days after his diagnosis, the patient was declared Ebola-free and released. Three other patients in the United States and Europe received similar treatment following the Emory University Hospital success.

On Oct. 8, Liberian national Thomas Eric Duncan, the first person diagnosed with Ebola on U.S. soil, died after he was placed on a ventilator and dialysis machine for just over a week at the Texas Health Presbyterian Hospital in Dallas, according to a Reuters report.

Martin Salia, a surgeon who contracted Ebola in his native country of Sierra Leone, was rushed into emergency dialysis after he showed no kidney function on Saturday, Nov. 15, The Washington Post reported. Salia died on Monday, Nov. 17.

On Friday, Nov. 14, however, a Ugandan man was released from the University Hospital Frankfurt after receiving a Hemopurifier dialysis treatment, which "targets viral pathogens and immunosuppressive toxins" released by the virus, according to an online Fox News article.

The authors of the Emory School of Medicine study expressed doubts when asked about the Hemopurifier technology.

"I think this concept has been used in one patient – we can't draw conclusions yet," Kraft said.

According to Franch, studies have proven the effectiveness of the technology, but by the time the studies were conducted, the viral components targeted by the Hemopurifier were already beginning to drop in number.

Regular hemodialysis, let alone a cutting-edge Hemopurifier, the doctors said, will not be an option for West African nations in the near future.

"They have trouble just keeping laboratories working [in West Africa]," Franch said, adding that if the region's medical centers were better able to supply patients with intravenous fluids and other treatments common to the developed world, patients may not even come to need dialysis in the first place.

"Right now the mortality rate is about 50 to 70 percent," he said. "With intravenous fluids, we could probably reduce that to around 20 to 30 percent. With dialysis, theoretically we should be able to save another 30 to 40 percent [of those patients]."

Connor stressed the lack of infrastructure in West African countries most affected by the virus, like Guinea, Sierra Leone and Liberia.

"[Dialysis] is very labor intensive, very resource intensive, and they're still struggling to provide basic resources, such as aggressive IV fluid resuscitation, basic labs and nursing support," Connor said.

But in more developed countries like the U.S., the life-support method can and should be used aggressively, the lead authors said.

"The big points are that we're able to do this safely and the patient actually recovered quite nicely," Franch said. "If you do it safely, your patient can actually recover."

In addition to Kraft, the study's other co-authors include Dr. Aneesh Mehta, Dr. Jay B. Varkey, Dr. Marshall Lyon, Dr. Ian Crozier, Dr. Ute Ströher and Dr. Bruce Ribner. The ASN was not available for comment.

– By Lydia O'Neal, Staff Writer

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