ABSTRACT
End stage kidney disease (ESKD) patients are vulnerable to medical and psychosocial difficulties. We aimed to identify specific concerns for ESKD patients during the early months of the COVID-19 pandemic. Surveys were administered to adult ESKD patients receiving dialysis in three units run by a large dialysis organization affiliated with an academic nephrology practice. Multiple choice and open-ended questions were used to assess patients’ perceptions of access to care and essentials of daily living, and effects of changes in dialysis schedules or prescriptions. Screening questions were used to assess patient anxiety and depression. 172 ESKD patients on dialysis were surveyed. Participants on home dialysis modalities [peritoneal dialysis (PD) or home hemodialysis (HHD)] more commonly reported feeling “very connected” to their dialysis care teams compared to patients on in-center hemodialysis (ICHD) (PD: 74.1%;HHD: 66.7%;ICHD: 62.3%). Patients who identified as White more commonly reported feeling “very connected” compared to patients who identified as non-White (White: 74.4%;Black/African American: 60.5%;Hispanic: 69.6%). Patients with histories of anxiety or depression more commonly reported feeling less cared for during the pandemic. 16.9% of participants reported new transportation issues, 6.4% reported difficulty obtaining medications, and 9.3% reported difficulty getting groceries. A minority of patients met screening criteria for depression or anxiety, though patients with self-reported histories of anxiety or depression had higher screening scores. Five themes emerged as influencing patient experiences: 1) the positive influence of relationships with dialysis staff;2) the value of interactions with family or other caretakers;3) difficulties with access to care;4) changes in physical and mental health;and 5) awareness of, and response to, the COVID-19 pandemic. Our study identifies sub-populations of ESKD patients who may be more vulnerable during the COVID-19 pandemic: those with histories of anxiety or depression, non-White patients, and patients on ICHD. Use of home dialysis modalities may be associated with better patient perceptions of care.