Dr. Robert Kossmann has a unique perspective of kidney care as the chief medical officer for Fresenius Medical Care North America and head of renal therapies for the company’s global medical office.
Germany-based Fresenius is the world’s largest provider of dialysis equipment and dialysis services, offering treatments at traditional dialysis centers as well as in patients’ homes.
Medical Design & Outsourcing recently spoke with Kossmann about kidney care in the pandemic, the challenges and benefits of home dialysis, logistics lessons learned and growth opportunities that medtech designers and engineers should keep in mind.
This conversation has been lightly edited for space and clarity.
MDO: What does COVID do to the kidneys during and after an infection, maybe even years after an infection?
Kossmann: To state the obvious — but it’s an important grounding point — COVID’s only been with us since probably the end of 2019 … and that really influences how much we can predict about what’s going to happen in the future. What we’ve clearly seen is that COVID, like all viruses, is evolving. In the earliest part of the pandemic here in the United States specifically, but even globally, it really caught fire in the first half of 2020 and we saw a lot of acute kidney injury. A lot of people got severely ill from COVID. It was the original form of COVID-19, so a higher degree of illness, big time inflammatory storm in these individuals who got hospitalized, and then a high proportion of those that were hospitalized — up to 60% — had some kind of kidney involvement, particularly those in the critical care units, and we saw people needing dialysis on a temporary basis in a sub-portion of those.
MDO: What are you seeing more recently?
Kossmann: Fast forward two years later, the last six months we are seeing more COVID infections, but the virus has evolved. And obviously we’re all used to talking about the BA.1 variant, the Omicron variant, and happily we’re seeing less severe illness, less of that inflammatory storm and less acute kidney injury (at least getting severe enough to require dialysis) and less intensive care unit involvement. We do know because there’s data that the kidney is involved directly, not just from the inflammatory storm, and that there are some effects from the COVID-19 virus in the kidney itself. We’re not sure how that’s going to play out over time because not enough time has gone by. But some individuals who were already at risk — from diabetes, from hypertension, from preexisting kidney injury — that kidney damage they had coupled with the kidney injury they received during their COVID illness, we have real concerns that it is going to result in some further permanent loss of kidney function. How that may play out with respect to progression is yet to be determined. And particularly for those people who had these underlying conditions, some of the new drugs that are on the market that are allowing us to treat their kidney disease, like the SGLT2 inhibitor class, may help some of those patients. But it’s an unclear picture. What we do know is that patients will continue to progress, those who have chronic kidney disease. We know that they’ll continue to be people who will eventually need a …….