Precautions help control risk of COVID-19 for patients on more frequent dialysis
Click Here to Manage Email Alerts
ORLANDO – A clinic in Brazil that continued in-center short daily dialysis through the pandemic reduced the risk for spreading COVID-19 among patients and staff by controlling transportation and using universal precautions, according to a poster presented here.
“[The] COVID-19 pandemic imposed several restrictions to the general population, including stay at home guidance,” Istenio F. Pascoal, MD, PhD, co-founder and administrative director of Centro Brasiliense de Nefrologia e Diálise, and colleagues wrote.
“Most dialysis patients are challenged by mandatory transportation and thrice-weekly long stays in their Units. Home dialysis and/or reduction of hemodialysis frequency have been promoted to mitigate the spread.
“Notwithstanding, we report the contrasting experience of keeping a long-term, in-center short daily hemodialysis program while enforcing protective measures and a unique transportation arrangement,” Pascoal and colleagues wrote.
The clinic treats 80 private-insured patients on in-center, short daily hemodialysis (six to seven times/week) using single-use high-flux dialyzers. From March 16, 2020, to March 15, 2022, the staff tested for SARS-CoV-2 among those patients who were symptomatic, hospitalized for other reasons or had contact with confirmed cases of COVID-19.
To mitigate the risk of infection, the clinic provided round-trip transportation between the home of the patient and the dialysis clinic. Eating during dialysis was abolished, and patients with a confirmed or suspected case of infection were dialyzed in isolation rooms. “A three-dose vaccination started in January 2021 and covered all patients and staff members,” Pascoal and colleagues wrote.
Results showed that 40 of 80 patients (50%) contracted COVID-19 and four were reinfected. Thirty of the 44 infections were symptomatic and 14 were asymptomatic.
“Ten of the 40 infected patients were hospitalized (25%), one required mechanical ventilation and died, while 39 recovered well (5% fatality rate pre-vaccination, 0% post-vaccination),” Pascoal and colleagues wrote. “Over the 2 years, dialysis mortality and transplantation rates were 5.6% (9/80 patients). Average dialysis frequency was 5.9 sessions/week. Our 100-member staff presented 33 COVID-19 infections,” the researchers wrote.
During the 2 years of the COVID-19 pandemic “we kept our in-center short daily hemodialysis schedule as usual while applied comprehensive transportation and restrictive measures,” the researchers wrote. “There was one death attributable to COVID-19, in sharp contrast with the death toll [in the] dialysis population worldwide (20% to 30% fatality rate). “This benign course may reflect a combination of strict prophylactic discipline (limiting transmission among patients and staff) with a potential inflammatory mediators’ removal by high-frequency high-flux hemodialysis (perhaps preventing cytokine storm).”
Collapse
Pascoal IF, et al. Poster #TH-959. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
Read more about
Click Here to Manage Email Alerts