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Abstract: PO0717

Chronic Dialysis Access Management in the COVID-19 Era: The Need for Raising Awareness

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Vincent-Johnson, Anita, University of Virginia, Charlottesville, Virginia, United States
  • Kannan, Lakshmi, University of Virginia, Charlottesville, Virginia, United States
  • Karimi, Ashkan, Augusta Health, Fishersville, Virginia, United States
  • Chopra, Tushar, University of Virginia, Charlottesville, Virginia, United States
  • Pourafshar, Negiin, University of Virginia, Charlottesville, Virginia, United States
Background

Coronavirus Disease 2019 (COVID-19), an acute respiratory disease caused by novel coronavirus SARS-CoV-2, is particularly ominous to chronic dialysis patients as they are likely to experience more severe illness. However, these patients continue to require renal replacement therapy (RRT) during this time. To inform best practices for hemodialysis (HD) patients, we sought to determine the challenges regarding access placement during the pandemic era.

Methods

This is a retrospective single-center study of adult patients who received chronic dialysis at one of the University of Virginia dialysis units. Prevalence of central venous catheter (CVC) use were assessed in patients receiving chronic HD between the months of February-April 2020 (during the pandemic in our area) and compared to the three months prior (October-December 2019). The patients’ relevant clinical and laboratory information were reviewed and recorded monthly. All patients who received RRT on HD were included.

Results

A total of 58 patients were evaluated, among whom 33 were male and 25 were female. The age range is 18-90 with a median age of 65. The number of patients using catheters in the pandemic months was 18 (31%), 19 (33%) and 22 (37%). The numbers pre-pandemic were 14 (25%), 19 (33%) and 17 (30%). The number of patients with central venous catheter for more than 90 days during the pandemic was 14 (24%), 16 (30%) and 16 (30%). The numbers pre-pandemic were 12 (22%), 15 (27%) and 15 (27%).

Conclusion

This single-center study reveals the impact of the pandemic on HD catheter use in our area. There is a large population of ESRD patients in the United States on HD that require vascular access. An AVF is the desired access type as it has the most extended access survival, the best patient survival outcomes, the lowest cost, and requires the fewest interventions. Early referral for AVF is important; however, during the Covid-19 pandemic era patients and providers are hesitant to refer patients, wanting to avoid any exposure to the virus while resources remain scarce. This study identifies the inherent difficulty for access placement in this high-risk population of patients during times like this and raises questions in the literature on the best choice of access for these patients along with the optimal timing of fistula placement to provide safe care for the patients.