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Kidney Week

Abstract: PO0746

Contingency Planning for COVID-19: Feasibility of Twice Weekly Hemodialysis in a Large Canadian Cohort

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Clark, David, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • West, Kenneth A., Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Tennankore, Karthik K., Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
Background

Reducing hemodialysis treatments from three times weekly to twice weekly is a potential strategy to lessen potential exposure/transmission of COVID-19 while allowing hemodialysis units to operate with fixed/reduced resources. As part of contingency planning at a large Canadian center, all facility-based hemodialysis patients were reviewed in advance for candidacy of a reduced “twice weekly” schedule.

Methods

All prevalent patients receiving at least thrice weekly, facility-based hemodialysis - affiliated with the QEII Halifax, Nova Scotia, Canada - were systematically reviewed in a stepwise manner, using accepted criteria for implementing twice weekly hemodialysis (Fig. 1).

Results

Of 473 patients assessed, only 18 (4%) fulfilled criteria for twice weekly hemodialysis (Fig 1.) Of these patients, average age was 63 ± 12 (SD) years, 61% were diabetic, 95% Caucasian; and at least 67% receiving dialysis for 6+ months prior to assessment. 83% of qualifying patients missed 0 treatments in the preceding month, and none missed >1 treatment. Average for serum albumin was 36 ± 4 g/L, Urea reduction ratio, 72.7, and residual urea clearance, 5.7 ± 2.7 mL/min/1.73m2.

Conclusion

Although feasible, a twice weekly hemodialysis strategy applied to a small proportion of our patient population, potentially reflecting an 'intention to defer' strategy for initiating dialysis.

Figure 1. Stepwise approach and selection criteria to review all facility-based hemodialysis patients for candidacy of twice weekly hemodialysis (N=473).*Patients who fulfilled interdialytic fluid gain and serum potassium criteria were assessed by primary nephrologist for eligibility using each of: III. good nutritional status, IV. no clinical evidence of fluid overload, and VI. infrequent hospitalization/easily manageable co-morbid conditions (cardiovascular and pulmonary).