ABSTRACT
Background: Patients receiving chronic hemodialysis (HD) are highly vulnerable in all settings. It is unknown whether the COVID-19 pandemic has disproportionately affected the care of chronic HD patients in low (LIC) and low-middle income (LMIC) settings. This survey aimed to identify global challenges and inequities in HD care delivery during the COVID-19 pandemic. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) and the International Society of Nephrology (ISN) conducted a global online survey of HD units (HDU). Sample HDUs included DOPPS sites in China, a random sample stratified by region and HDU population, and an open invitation via ISN's membership list. The survey assessed availability of COVID-19 diagnostics and personal protective equipment, the impact of COVID-19 on HD delivery and patient outcomes from COVID-19. Responses were stratified by country income according to World Bank classification. Results: Responses were received from 412 HDUs across 78 countries (Table 1). Conclusions: Striking global inequities were identified in access to COVID-19 diagnostics, infection prevention, and access to routine HD care during the pandemic. Higher apparent mortality in patients on chronic HD in LICs and LMICs is likely multifactorial, reflecting poorer access to the diagnosis and care of COVID-19, as well as greater disruptions to HD delivery. Urgent action is required to address these inequities, which disproportionately affect low-income settings, exacerbate pre-existing vulnerabilities and lead to worse outcomes.
ABSTRACT
Background: Haemodialysis units (HDUs) have had to rapidly adapt practices and policies to safely continue life-sustaining HD services during the COVID-19 pandemic. We aimed to describe the impact of COVID-19 in different parts of the world. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) and International Society of Nephrology (ISN) collaborated to web-survey individual HDUs. Responses were obtained in three ways: (1) a survey of DOPPS sites in China (May/ June 2020), (2) a random sample (20 units if > 40 units/ country;all units if < 40) stratified by region and HDU census (November 2020 -March 2021), and (3) an open invitation via ISN's membership list and social media (March 2021). Responses were compared between the ten ISN regions. Results: There were returns from 412 HDUs (46% public sector, 79% urban;70% adult, 2% paediatric, 28% adult & paediatric) from 78 countries (9% low-, 24% lowermiddle-, 28% upper-middle-, 39% high-income). Conclusions: The COVID-19 pandemic has had a significant impact on dialysis services and staffing worldwide. Differences in uptake of policies and practices across regions have likely been because of variable access to resources to enable implementation of diagnostic testing algorithms and adequate supply of PPE to implement infection prevention and control recommendations. Guidance should be consistent, adaptable to (nearly) all situations and locations, and evidence based. Going forward, the operationalisation of vaccine programs should be incorporated into guidelines. Disruptions to dialysis services should be minimised, and resource provision (including vaccines) prioritised by policymakers and governments in future waves of COVID-19 and pandemics if we are to protect HD patients, staff, and services.
ABSTRACT
Background: Home dialysis may be able to minimize SARS-CoV2 exposure risks. The pandemic may have introduced unique challenges related to supply disruption and care delivery changes. We sought to assess the global burden of COVID-19 on peritoneal dialysis units (PD) and understand PD unit practice changes during this time. Methods: The Peritoneal Dialysis/Dialysis Outcomes and Practice Patterns Study (PDOPPS/DOPPS) and International Society of Nephrology (ISN) administered a webbased survey (1) to dialysis units selected based on a random sample stratified by region (November 2020 -March 2021), and (2) to an open invitation via ISN's membership list and social media (March 2021). Responses were compared across 10 ISN regions. Results: Returned surveys included 167 PD facilities across 52 countries. Changes in several care domains including clinic communication and frequency, labwork frequency, method of communication, masking policies, changes in handling of PD effluent among infected individuals, PD supply disruption, access to methods of PD catheter insertion and frequency of new patient training are highlighted (table). Conclusions: Variability exists in routine PD care, and the availability and use of PPE, disruption in PD supplies among the different regions reflecting the availability of the resources and infrastructure differences. LMIC tended to be more severely impacted-this gap needs to be addressed in anticipation of future pandemics for treatment continuity. Although remote technology use among PD patients to communicate with their physicians has increased during the pandemic, optimal communication frequency, methods and schedule of routine bloodwork needs to be better elucidated.
ABSTRACT
Background: Minimising patient contact is more important amidst the COVID-19 pandemic;yet altering follow-up data collection methods may introduce unintentional bias. We describe our findings from the European Quality (EQUAL) study in which UK patients switched from 'traditional' clinic follow-up (TFU) to 'efficient' postal follow-up (EFU). Methods: EQUAL is a prospective study on treatment in people aged ≥65 with advanced chronic kidney disease (eGFR ≤20mL/min/1.73m2). UK patients were recruited to EQUAL from 2013-2017. During TFU, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months. In 2018, all alive patients were invited to switch to EFU, which used an abbreviated questionnaire administered centrally by post. Questionnaire response and error rates for six-monthly TFU and the first EFU are presented for UK patients who consented to EFU. Results: In total, 506 UK patients were recruited. In 2018, 236 of these patients were alive and almost half (n=111) consented to the change in follow-up. Of those consenting to EFU, response rates fell from 88.2% (98/111) to 59.0% (65/110) for patients who completed 1.5 years of TFU. Of those who were recruited earlier and had completed 3.5 years of TFU, response rates fell again to 20% (3/15). The response rate for the first EFU questionnaire was 59.6% (59/99) of those alive. Errors almost trebled throughout TFU, before falling to baseline at the first EFU. Conclusions: In this prospective study of older people with advanced CKD, response rates fell and error rates rose during TFU. On introducing a shorter postal questionnaire, response and error rates improved to levels resembling early TFU. This suggests that even in older people with advanced CKD, returning questionnaires by post is acceptable and may provide more complete data than costly TFU. This is acutely relevant in this period of limited contact in the COVID-19 pandemic.