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1.
BMJ Open ; 12(12):e065112, 2022.
Article in English | PubMed | ID: covidwho-2193785

ABSTRACT

OBJECTIVE: Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally. SETTING AND PARTICIPANTS: Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021. RESULTS: Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries. CONCLUSION: Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.

5.
Journal of the American Society of Nephrology ; 32:87-88, 2021.
Article in English | EMBASE | ID: covidwho-1490194

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.

6.
Journal of the American Society of Nephrology ; 32:81, 2021.
Article in English | EMBASE | ID: covidwho-1489341

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.

7.
Journal of the American Society of Nephrology ; 32:92-93, 2021.
Article in English | EMBASE | ID: covidwho-1489301

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.

8.
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448423

ABSTRACT

Introduction: Health care workers (HCW) are exposed to SARS-CoV-2 through patient contact. Objectives: We aimed to assess the seroprevalence for SARS-CoV-2 among HCW in the canton Grisons and analyze risk factors associated with seroconversion. Methods: HCW from 13 health care institutions were recruited. Sera were analyzed for SARS-CoV-2 antibodies using an electro-chemiluminescence immunoassay of Roche Diagnostics in mid-2020 (survey I) and early 2021 (survey II). Participants reported risk factors for COVID-19 in a questionnaire.Odds ratios (OR) and 95% confidence intervals (95% CI) for the association of seropositivity with each risk factor were determined by logistic regression. Results: SARS-CoV2 serology was positive in 99 of 2794 (3.5%) participants in survey I and in 376 of 2315 (13.5%) participants in survey II. By survey II, 86 of 88 (97.7%) initially seropositive participants remained seropositive. In multivariable analysis of both surveys, the strongest association for SARS-CoV-2 seroconversion was contact with a household member with COVID-19 (adjusted OR: 21.2, 95% CI: 8.5-51.4, p < 0.001, survey I;aOR: 8.5, 95% CI: 6.0-12.1, p < 0.001, survey II). Significant occupational risk factors included contact with patients with COVID-19 in both surveys (aOR: 2.7, 95% CI: 1.4-5.4, p < 0.001, survey I and aOR: 1.4, 95% CI: 1.0-2.2, p = 0.046, survey II). Contact to a SARSCoV- 2 positive co-worker was a significant risk factor only in survey I, whereas private contact with SARS-CoV-2 positive persons and the COVID-19 incidence in the region of the HCI were associated with seroconversion only in survey II. Conclusion: Contact with patients with COVID-19 was an important risk factor for seroconversion, although the risk was higher for household contacts. These findings highlight the need to optimize preventive measures for SARS-CoV2 infection among HCW.

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