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Dialysis providers and patients struggle with supply shortage

National Institute of Health

Dialysis patients across the nation are feeling the effects of blood-cleaning solution shortages, including in South Dakota.

Patients diagnosed with kidney disease must undergo treatment three times a week to filter their blood. Blood is filtered through a dialysis machine that contains an acid bicarbonate solution. Dialysis acts on behalf of kidneys to balance acid and water levels.

“The kidneys also help regulate electrolyte balances. That’s why we put the acid concentrate and the acid [bicarbonates] in the solution so that we can keep an eye on the electrolytes and the potassium and the calcium.”

That’s Mike Thompson, the director of dialysis at Monument Health in Rapid City. He says the health system was aware of the shortage in December and created a plan to conserve resources. Monument Health is decreasing the dialysis flowrate, which is the amount of dialysis solution. The acid bicarbonate solution is being reduced from around 700 milliliters per minute to 600 for most patients.

“The reason they did that is that our medical director said that there’s very little impact at that reduced level, so that will save us a little bit and we’re comfortable with that," Thompson said.

Around 175 patients who receive dialysis in Rapid City and Spearfish received letters from Monument Health informing them of the flowrate decrease in their treatment. The decrease started last month.

Fresenius is the largest of two suppliers of acid bicarbonate solutions in the United States. In a statement released in January, the company said it’s experiencing a severe labor shortage. Workers cannot keep up with manufacturing and transportation of supplies.

Taya Swanson manages sourcing of the supply chain at Avera Health in Sioux Falls. Her team identified shipment changes earlier and created plans for conserving acid bicarbonate supplies.

“We also worked very closely with our primary supplier to help us understand what our allocations would be from them and then we also worked with a secondary supplier," Swanson said.

Junaid Syed is a nephrologist at Avera Health. He said dialysis treatment at Avera has not changed. The health system serves over 700 dialysis patients.

Maria Regnier, senior director for dialysis services at Sanford Health in Sioux Falls, said Sanford reduced flowrates recently.

“There are a few patients who we are going to have to leave on higher flowrates just because of the size of those patients and they make more waste products, so we have to leave them up higher,” Regnier said. “So, it’s very individualized what we’re trying to do.” 

Sanford treats about 600 dialysis patients.