학술논문
Safely reducing haemodialysis frequency during the COVID-19 pandemic
Document Type
article
Author
Michelle Da Silva Lodge; Thilini Abeygunaratne; Helen Alderson; Ibrahim Ali; Nina Brown; Constantina Chrysochou; Rosie Donne; Ibi Erekosima; Philip Evans; Emma Flanagan; Simon Gray; Darren Green; Janet Hegarty; Audrey Hyde; Philip A. Kalra; Elizabeth Lamerton; David Lewis; Rachel Middleton; David New; Robert Nipah; Donal O’Donoghue; Edmond O’Riordan; Dimitrios Poulikakos; Francesco Rainone; Maharajan Raman; James Ritchie; Smeeta Sinha; Grahame Wood; J. Tollitt
Source
BMC Nephrology, Vol 21, Iss 1, Pp 1-10 (2020)
Subject
Language
English
ISSN
1471-2369
Abstract
Abstract Background 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. Methods Dialysis 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. Results There 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. Conclusions Short 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.