ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2021 and some content may be unavailable. To unlock all content for 2021, please visit the archives.

Abstract: PO0809

Reducing Haemodialysis Frequency in a Satellite Unit During the COVID-19 Pandemic

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Brooks, Owain, Swansea Bay University Health Board, Swansea, Swansea, United Kingdom
  • Aithal, Sadananda V., Swansea Bay University Health Board, Swansea, Swansea, United Kingdom
  • Richards, Aled W., Swansea Bay University Health Board, Swansea, Swansea, United Kingdom
  • Davies, Bethany, Swansea Bay University Health Board, Swansea, Swansea, United Kingdom
  • Birchall, James C., Cardiff University, Cardiff, School of Pharmacy and Pharmaceutical Sciences, United Kingdom
  • Parnell, Hannah E M, Cardiff University, Cardiff, School of Pharmacy and Pharmaceutical Sciences, United Kingdom
  • Samuels, Eden, Cardiff University, Cardiff, School of Pharmacy and Pharmaceutical Sciences, United Kingdom
Background

People dependent on unit HD are vulnerable to COVID-19. We describe the safety and outcomes of reducing HD frequency to minimise patient exposure to the virus.

Methods

HD was reduced from thrice to twice-weekly in selected patients for 9 weeks from March 2020. Urine output, heart failure, fluid-overload, hyperkalaemia, medication and patient preference were considered. Patients were asked to restrict dietary potassium, salt and fluid. Selected patients reducing HD frequency received 10g once-weekly sodium zirconium cyclosilicate (SZC).

Group 1: Continue thrice-weekly HD
Group 2: Twice-weekly HD +SZC
Group 3: Twice-weekly HD -SZC.

Pre-HD serum potassium (sK+) and bicarbonate (sHCO3-), systolic blood pressure (SBP) and weights were monitored. COVID-19 transmission, hospitalisation and death were recorded.

Results

Of 77 patients (mean age 70 years, 74% male), 17 continued thrice-weekly HD. 60 patients reduced to twice-weekly HD, of which 43 received SZC.

There were 494 fewer HD treatments over 9 weeks.

There was no significant difference in mean monthly sK+ in any group between March (pre-intervention), April and May; but 6 patients returned to thrice-weekly HD early due to hyperkalaemia or fluid-overload.

SZC was increased to 10g twice-weekly in 15 patients.

There was a reduction in mean monthly sHCO3- during twice-weekly HD. No changes were made to oral or HD bicarbonate prescriptions.

There was no significant difference in pre-HD weight or SBP from baseline in patients dialysing twice-weekly.

Only 2 of the 14 admissions over 9-weeks were related to hyperkalaemia or fluid-overload. 5 patients tested positive for COVID-19.

2 of the 3 deaths during this period were due to COVID-19. Both were elderly males with CVD and chronic respiratory disease. 1 patient died of a MI after returning home from HD. No deaths were attributed to a reduction in HD frequency. There was no evidence of COVID-19 transmission on the HD unit. No patients were transferred to the regional hub for HD due to COVID-19.

Conclusion

Reducing HD frequency in carefully selected patients is safe, and with strict infection control and timely COVID-19 testing, can reduce COVID-19 transmission and patient transfer to HD hubs. Dietetic review and SZC can reduce hyperkalaemia. Improved documentation of urinary output and cardiac function would optimise this approach.