Impact of the COVID-19 pandemic on dialysis patients

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by Victoria Wang Yue & Sheena Gow

COVID-19. This is on the forefront of many of our thoughts these days. While this virus is infecting the general population, the exacerbations of pneumonitis and secondary bacterial pneumonia are more pronounced in populations who already have pre-existing health conditions like hypertension, heart failure, diabetes, chronic kidney disease (CKD), asthma or chronic obstructive pulmonary disease (COPD). With ESKD patients on dialysis, they are at increased risk as they usually have co-morbidities.

With their kidneys ineffective, most dialysis patients endure a challenging regimen of having their blood cleansed three days a week, typically four hours each time (hemodialysis-HD). This is done mainly in dialysis centers where 8 to more than 30 chairs are placed in a large single room. Globally, a majority of patients undergo in-center dialysis, while relatively smaller percentage of patients receive their care at home (mostly peritoneal dialysis). The nature of their kidney disease makes dialysis patients highly vulnerable to complications of infection and other threats from co-morbidities. Even a single missed session can cause life-threatening results like fluid buildup in their lungs and hearts. In addition, during a severe infection, more medications are being used in the COVID treatment and these can be harmful to an already compromised kidney. It may result in an acute kidney injury which can be lethal for ESKD patients.

The challenges to the ongoing provision of maintenance out-patient hemodialysis are significant in the current pandemic situation. In addition to their medical conditions, they will be exposed to staff and other patients at the center who might have the same risk profiles as themselves. On the other hand, with PD patients, whilst they might also be impacted by delayed logistics of medical supplies reaching them/the dialysis centers due to major airline/transportation disruptions, having home dialysis is still advantageous as their exposure to the outside world is greatly reduced.

It is in dire times that health disparities are more pronounced and this is an opportune time for the dialysis world to rethink health processes and to innovate ways to bring health treatment to the unwell without potentially causing them more risk of serious morbidity and mortality during a pandemic.

This article was written based on the information from Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int. 2020;In press

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