Abstract
BackgroundPatients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients.MethodsDialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice.ResultsThere were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project.ConclusionsShort term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.
Highlights
Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19
No definitive inclusion criteria were specified but only named patients dialysis consultants were asked to consider suitability for twice weekly based upon their review of interdialytic weight gain, pre dialysis blood pressure and potassium, residual renal function, comorbidity and functional status
Patients who were transferred to twice weekly dialysis were more likely to be older, with lower ultrafiltration volumes, greater urea reduction ratio (URR), shorter dialysis vintage and to have lower pre-dialysis phosphate and potassium levels
Summary
Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. Severe Acute Respiratory Syndrome Coronavirus-2 has developed into a worldwide pandemic, with over 44 million documented cases and 1.1 million deaths worldwide. Medical comorbidities such as hypertension, diabetes mellitus, asthma, obesity and chronic kidney disease are reported as significant predictors of morbidity and mortality in COVID-19 patients [1, 2]. UK Renal Registry data up to 7th October 2020 has reported
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