ABSTRACT
It has been reported that older pts adapt better to dialysis than younger pts. We investigated in response by age to various stressors encountered during the COVID-19 pandemic in a population of inner-city dialysis patients. A survey was conducted in a random sample of 32 dialysis patients. Patients were asked about their fluid intake, general attitudes towards medical recommendations, and changes in their wellbeing due to COVID19. The PSS (Perceived Stress Scale) and KAS-R (Kim Alliance Scale Revised) were also used. Mean age was 56.8 ± 18.2 years. 15 pts (46.9%) were <60 yrs (younger) and 17 (53.1%) were ≥60 yrs (older). Mean dialysis time was 88.0 ± 104.0 months. There were 20 (62.5%) male, 29 (90.6%) identified as black, 18 (56%) had a high school diploma or less, and 14 (44%) completed some college or more. 7% (1) of older and 46% (6) of younger pts reported “some of the time” or “never” rather than "most of the time" when asked how often they followed the fluid restriction recommendations (p=0.034). 29% (4) of younger pts reported fluid restrictions were difficult to follow, vs. none of the older pts (p=0.037). 33% (5) of younger pts reported “poor” or “average” when asked about wellbeing prior to the pandemic and 100% (15) of older patients reported “good” (p=0.05). When asked to rate their stress level over the last year, 64% (9) of younger pts reported being somewhat or very stressed and 79% (11) of older pts reported not at all or a little stressed (p=0.015). 29% (4) of younger pts stated they sometimes work well with their provider and 100% (15) of older patients stated always (p=0.026). There were no statistically significant differences between the groups for sex, race, or education. In our population during the pandemic: 1. Younger pts were less adherent to fluid restriction and found them more difficult to follow. 2. Older pts were more likely to report feeling good prior to the pandemic and were less stressed following it. 3. Older pts were more likely to report a good relationship with their provider. 4. Younger pts may need more support through the pandemic as they appear to be coping less well, feel less connected, and are less able to follow important dietary restrictions. (Table Presented) This case highlights the uncommon sequelae of untreated primary hyperparathyroidism which is rare since the introduction of automated chemistry analyzers [2]. Pancreatitis is reported in < 3% of patients with hyperparathyroidism and is seldom seen in current practice. Nephrocalcinosis and pancreatitis are rare complications of untreated hyperparathyroidism and could have been averted with the definitive treatment of parathyroidectomy.
ABSTRACT
Understanding factors that impact vaccine hesitancy in underserved populations is of paramount importance. A random sample of 31 dialysis pts were surveyed regarding COVID-19 vaccination status, attitudes towards vaccines and perception of healthcare/government authority. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Mean age was 56.1 ± 17.9 yrs, time on dialysis 6.2 ± 7.2 yrs with 18 (58%) women, 13 (42%) men, 28 (90%) identified as black. 84% had received the vaccine. There were no statistically significant differences between VACYES and VACNO for age, time on dialysis, sex, race, education, insurance status, and presence of diabetes. VACYES were more likely to agree with trust in the information about the vaccine (r = 0.57, p < 0.001), felt confident about the safety and efficacy (r = 0.75, p < 0.001), and trusted government guidelines regarding COVID-19 (r = 0.73, p < 0.001). Pts who believed it was okay for the government to mandate vaccinations (r = 0.52, p = 0.003), mandate COVID-19 vaccinations (r = 0.58, p = 0.001), and believe we should all follow government guidelines to protect public health (r = 0.41, p = 0.02) were also more likely to be VACYES. They also believed that hospitals could care for them if sick with COVID-19 (r = 0.62, p < 0.001), felt they had an active partnership with their provider (r = 0.42, p = 0.02) and felt having regular contact with their physician was the best way to avoid illness (r = 0.38, p = 0.04). VACNO pts were more likely to say they had less contact with medical professionals regarding their dialysis restrictions (r = - 0.63, p < 0.001) and felt their provider did not listen to them (r = - 0.38, p = 0.04). In our population of inner-city dialysis patients: 1. The majority are vaccinated against COVID-19. 2. Pts were more likely to have received the vaccine if they had trust in the government regarding COVID-19 and in the healthcare system in general. 3. Pts who reported more shared decision making were more likely to receive the vaccine and this should be emphasized in education efforts for vaccine acceptance in our vulnerable population.