ABSTRACT
Introduction: The COVID-19 pandemic has affected the health services globally. The impact on the provision of vascular access services for patients with chronic kidney disease is not known. One can speculate that reduced hospital bed capacity, limited elective theatre lists, and the shielding requirement for vulnerable patients in this particular group will have an adverse effect. This study was conducted to evaluate the effect of the COVID-19 pandemic on dialysis access procedures performed at a tertiary care centre. Methods: This was a single centre, retrospective, observational study of all dialysis access procedures performed between January 2019 and December 2020. Patient data were collected from electronic patient records, operation theatre databases, and clinical case records. Vascular access procedures were categorised according to the site and type of dialysis access (autogenous/non-autogenous fistulas) and secondary access procedures. Secondary access procedures were those that dealt with complications of vascular access. Peritoneal access procedures were also included in the data. Placement of acute and long term dialysis catheter lines were excluded. Pre-COVID data from 2019 were compared with the 2020 data. Statistical methods for data analysis were performed using SPSS version 23.0 by applying Pearson’s chi square test for variables to measure the significance of outcome. Results: A total of 271 dialysis access related procedures were performed in 2019 versus 212 in 2020. There was a significant drop of 21.7% in the total number of dialysis access procedures during the COVID-19 pandemic in the year 2020 (p <.05). In the pre-COVID era, 162 (59.8%) procedures were the formation of autogenous arteriovenous fistulas. The case mix consisted of 69 (25.5%) radiocephalic fistulas, 70 (25.8%) brachiocephalic fistulas, 13 (4.8%) first stage basilic vein transpositions, and 10 (3.7%) second stage basilic vein transpositions. In comparison, during the year 2020, 118 (55.7%) procedures were autogenous arteriovenous fistulas. The case mix included 54 (25.5%) radiocephalic fistulas and a similar proportion of brachiocephalic fistulas (n = 54 [25.5%]), six (2.8%) first stage basilic vein transpositions, and four (1.9%) second stage basilic vein transpositions. There were 14 (5.2%) non-autogenous arteriovenous graft formations in 2019 versus 21 (9.9%) in 2020 (p <.05). There were 53 (19.5%) secondary vascular access procedures in 2019 versus 30 (14.1%) in 2020 (p <.05). The proportion of peritoneal dialysis catheter placements, repositioning, and catheter exchanges increased slightly. Forty-two (15.5%) procedures were done in 2019 versus 43 (20.3%) in 2020. The proportion of new peritoneal catheters was significantly higher in the year 2020 (p <.05). There were 35 (12.9%) new peritoneal dialysis catheter placements (nine laparoscopic/26 open insertions) in 2019, whereas in 2020 there were 38 (17.9%) n (one laparoscopic, 31 open and five percutaneous). There were no laparoscopic peritoneal dialysis catheter placements after the start of the pandemic. Conclusion: During the COVID-19 pandemic, there was a significant reduction in the total number of vascular access procedures performed and also secondary surgical interventions, but an increase in the use of arteriovenous grafts. The number of new peritoneal dialysis access increased despite overall reduction in the total number of procedures. Percutaneous peritoneal tube insertion technique was introduced during the pandemic to reduce hospital admissions while laparoscopic techniques were abandoned.