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Kidney Week

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.