Accesos para diálisis: Estableciendo prioridades en los procedimientos bajo pandemia de SARS-CoV-2/COVID-19

Abstract

Introduction: The COVID-19 pandemic, caused by SARS-CoV-2, forces health systems to reorganize the delivery of care in order to reduce the risk of exposure, especially to the elderly and patients with underlying comorbidities, such as those with End Stage Renal Disease (ESRD) receiving renal replacement therapy (RRT). Objectives: To issue recommendations for the management of ESRD patients needing dialysis access during the COVID-19 pandemic. Such guidelines seek to minimize the risk of SARS-CoV-2 procedural contamination to ESRD patients and to health care providers during the creation of a dialysis access. Methodology: The current guidelines for dialysis access in ESRD patients and the recommended changes under the pandemic were reviewed: 1) A thorough search of the most relevant articles and the international guidelines for creation of dialysis access prior to the pandemic, was conducted. 2) Such guidelines were then modified to address the following pandemic-related items: a) Indications to perform the procedure on a case by case basis, b) Procedural success, c) Operator-related issues, d) Facility-related issues. Results: The current guidelines on dialysis access are briefly described. The level of urgency and the changes in the current guidelines suggested by international medical societies are stratified. Appropriate and practical recommendations for the management of ESRD patients needing RRT during the current pandemia are outlined.