Predictors for Failure Reduction of Hemodialysis Frequency during the Pandemic

ABSTRACT

Introduction: A dialysis unit is compatible with a long-range airborne transmission environment resulting in a higher risk of Coronavirus disease 2019 (COVID-19) infection in hemodialysis patients. Reduction of hemodialysis frequency is a common practice to prevent COVID-19 from spreading in the dialysis unit. However, the predictors to determine which patient is likely to fail from reducing frequency of dialysis is still lacking. This study determined the predictors for a failure reduction in hemodialysis frequency at 4 weeks. Method(s) This retrospective observational study enrolled adult patients receiving long-term thrice-weekly hemodialysis at Thammasat University Hospital in 2021 who decreased dialysis frequency to twice-weekly during COVID-19 outbreak in Thailand. The outcomes were prevalence of failure reduction in dialysis frequency at 4 and 8 weeks and predictors of failure reduction at 4 weeks. Multivariable logistic regression analysis was performed to determine the predictors and create a predicting model for failure reduction of dialysis frequency. Result(s) Of 161 patients receiving hemodialysis in 2021, 83 patients with dialysis frequency reduction had a median age of 69.6 years and a median dialysis vintage of 4.5 years. 27 (33%) and 68 (82%) patients failed to reduce dialysis frequency at 4 and 8 weeks. At 4 weeks, 22 (81.5%) patients failed to reduce dialysis frequency from hypervolemia-related causes. From multivariate logistic regression analysis showed that the predictors for failure reduction at 4 weeks were pre-existing diabetes, congestive heart failure, pre-dialysis weight gain, dry weight from body composition measurement, mean pre- and post-dialysis weight gain during one week before dialysis reduction (Table 1). The model including these predictors (Table 2) demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.78 (95% CI 0.69-0.88) for predicting a failure reduction. At 4 weeks, 0 (0%), 7 (28.0%), and 20 (54.1%) of patients with low risk (score of <0 point), intermediate risk (score of 0-1 point) and high risk (score of >1 point) failed to reduce dialysis frequency, respectively. Conclusion(s) During the COVID-19 pandemic, 33% and 88% of hemodialysis patients failed to reduce their dialysis frequency at 4 and 8 weeks. The predicting model for a failure dialysis reduction demonstrated a good performance. Conflict of interest Potential conflict of interest - Speaker fee from Fresenius Medical Care and Boehringer Ingelheim (Thai) - Registration fee from Novo Nordisk and Sanofi Aventis ThailandCopyright © 2023