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A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic.
Basile, Carlo; Lomonte, Carlo; Combe, Christian; Covic, Adrian; Kirmizis, Dimitrios; Liakopoulos, Vassilios; Mitra, Sandip.
  • Basile C; Division of Nephrology, Miulli General Hospital, 70021, Acquaviva delle Fonti, Italy. basile.miulli@libero.it.
  • Lomonte C; Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy. basile.miulli@libero.it.
  • Combe C; Division of Nephrology, Miulli General Hospital, 70021, Acquaviva delle Fonti, Italy.
  • Covic A; Service de Néphrologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
  • Kirmizis D; Unité INSERM 1026 BioTis, Université de Bordeaux, Bordeaux, France.
  • Liakopoulos V; Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania.
  • Mitra S; Department of Nephrology, Colchester General Hospital, Essex, UK.
J Nephrol ; 34(2): 365-368, 2021 04.
Article in English | MEDLINE | ID: covidwho-1120210
ABSTRACT
The COVID-19 pandemic has resulted in major disruption to the delivery of both routine and urgent healthcare needs in many institutions across the globe. Vascular access (VA) for haemodalysis (HD) is considered the patient's lifeline and its maintenance is essential for the continuation of a life saving treatment. Prior to the COVID-19 pandemic, the provision of VA for dialysis was already constrained. Throughout the pandemic, inevitably, many patients with chronic kidney disease (CKD) have not received timely intervention for VA care. This could have a detrimental impact on dialysis patient outcomes in the near future and needs to be addressed urgently. Many societies have issued prioritisation to allow rationing based on clinical risk, mainly according to estimated urgency and need for treatment. The recommendations recently proposed by the European and American Vascular Societies in the COVID-19 pandemic era regarding the triage of various vascular operations into urgent, emergent and elective are debatable. VA creation and interventions maintain the lifeline of complex HD patients, and the indication for surgery and other interventions warrants patient-specific clinical judgement and pathways. Keeping the use of central venous catheters at a minimum, with the goal of creating the right access, in the right patient, at the right time, and for the right reasons, is mandatory. These strategies may require local modifications. Risk assessments may need specific "renal pathways" to be developed rather than applying standard surgical risk stratification. In conclusion, in order to recover from the second wave of COVID-19 and prepare for further phases, the provision of the best dialysis access, including peritoneal dialysis, will require working closely with the multidisciplinary team involved in the assessment, creation, cannulation, surveillance, maintenance, and salvage of definitive access.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arteriovenous Shunt, Surgical / Renal Dialysis / Delivery of Health Care / Pandemics / COVID-19 / Kidney Failure, Chronic Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: J Nephrol Journal subject: Nephrology Year: 2021 Document Type: Article Affiliation country: S40620-021-01002-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arteriovenous Shunt, Surgical / Renal Dialysis / Delivery of Health Care / Pandemics / COVID-19 / Kidney Failure, Chronic Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: J Nephrol Journal subject: Nephrology Year: 2021 Document Type: Article Affiliation country: S40620-021-01002-4