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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Abstract: PO0102

COVID-19 Pandemic Highlights Global Inequities in Chronic Hemodialysis Care: A DOPPS/ISN Survey

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)


  • Tannor, Elliot Koranteng, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Singh Shah, Dibya, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Phiri, Chimota Thomas, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
  • Evans, Rhys David Russell, The University of British Columbia, Vancouver, British Columbia, Canada
  • Aylward, Ryan E., University of Bristol, Bristol, United Kingdom
  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Caskey, Fergus, University of Bristol, Bristol, United Kingdom
  • Liew, Adrian, Mount Elizabeth Medical Centre, Singapore, Singapore
  • Luyckx, Valerie A., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Jha, Vivekanand, The George Institute for Global Health, New Delhi, India
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Dreyer, Gavin, Barts Health NHS Trust, London, London, United Kingdom

Group or Team Name

  • ISN DOPPS collaboration

Patients receiving chronic hemodialysis (HD) are highly vulnerable in all settings. It is unknown whether the COVID-19 pandemic has disproportionately affected the care of chronic HD patients in low (LIC) and low-middle income (LMIC) settings. This survey aimed to identify global challenges and inequities in HD care delivery during the COVID-19 pandemic.


The Dialysis Outcomes and Practice Patterns Study (DOPPS) and the International Society of Nephrology (ISN) conducted a global online survey of HD units (HDU). Sample HDUs included DOPPS sites in China, a random sample stratified by region and HDU population, and an open invitation via ISN’s membership list. The survey assessed availability of COVID-19 diagnostics and personal protective equipment, the impact of COVID-19 on HD delivery and patient outcomes from COVID-19. Responses were stratified by country income according to World Bank classification.


Responses were received from 412 HDUs across 78 countries (Table 1).


Striking global inequities were identified in access to COVID-19 diagnostics, infection prevention, and access to routine HD care during the pandemic. Higher apparent mortality in patients on chronic HD in LICs and LMICs is likely multifactorial, reflecting poorer access to the diagnosis and care of COVID-19, as well as greater disruptions to HD delivery. Urgent action is required to address these inequities, which disproportionately affect low-income settings, exacerbate pre-existing vulnerabilities and lead to worse outcomes.

Distribution of responses regarding resources, practices, and outcomes during the COVID-19 pandemic, by World Bank country income classification