Impact of COVID-19 on Patients Undergoing Scheduled Hemodialysis Operations

Abstract

The objective of this study was to determine the impact of the current COVID-19 pandemic in patients in end-stage renal disease (ESRD) who were scheduled for interventions related to hemodialysis (HD) accesses and had to be postponed secondary to the pandemic in centers in the United States. An interim analysis of the VASCC Project 1: Impact of COVID-19 on Scheduled Vascular Operations United States data was performed. Modules were developed by international vascular surgeon working groups and extensively beta-tested before implementation. A REDCap database was developed and registered information of patients with ESRD whose HD access procedures were postponed during the COVID-19 pandemic included in the interim analysis. Demographic variables, time frame of surgical delay, and planned procedure information are reported. A total of 177 patients with ESRD undergoing dialysis intervention whose surgeries were postponed during the COVID-19 pandemic surge in the United States were included in the interim data analysis. The mean age was 58.3 years (standard deviation, 14.9 years), with 96 (54.2%) being male. Of the 177, 47 (26.6%) patients were white non-Hispanic, 60 (33.9%) were Hispanic, 14 (7.9%) Asian or Pacific Islander, and 46 (26%) were Black non-Hispanic. The planned procedures are represented in the Table. The most common postponed procedure was new creation for ESRD (n = 129; 72.9%), and the second most common was intervention for failing arteriovenous fistula or graft in 26 patients (14.7%). The average days of delay was 71.7 (standard deviation, 50.9). Of the 177 patients, 132 (74.6%) successfully completed surgery at time of data entry. At the time of completion of the case report form, 44 (24.9%) were still awaiting surgery. One patient (0.6%) decompensated and required an emergency surgery during the delay. One patient (0.6%) died waiting for surgery, and 5 (2.66%) died within the first 30 days of surgery. One patient had to initiate HD with a dialysis catheter during the study period. COVID-19 pandemic has meant a paradigm shift in patient care. Patients requiring HD access are no exception and likely warrant closer evaluation due to often urgent to emergent care they require. The delay of these procedures could change the patient's possibilities for HD access as well impact in their quality of life and life expectancy. Unfortunately, until the completion of this report, 44 (24.9%) patients were still awaiting procedures. No doubt COVID-19 have changed the global health policies and strategies. We must adapt to the circumstances in the care of patients with ESRD and implement strategies to minimize these delays.TableIndication for planned proceduresIndicationNo. (%) n = 177New creation129 (72.9)Failing arteriovenous fistula or graft26 (14.7)Thrombosis3 (1.7)Steal syndrome1 (0.6)Ulcer1 (0.6)Infection1 (0.6)Enlarging aneurysm4 (2.3)Other12 (6.8) Open table in a new tab