Abstract: TH-PO959
Paradoxical Protection of Keeping an In-Center Short Daily Hemodialysis Schedule During the First 2 Years of COVID-19 Pandemic
Session Information
- COVID-19: Vaccines and Outcomes ESRD/KTR
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Pascoal, Istenio, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
- Simon, Adolfo, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
- Lins, Luiza, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
- Xavier, Kelia, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
- Bello, Vilber, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
- Lauar, Juliane, Centro Brasiliense de Nefrologia Dialise, Brasilia, DF, Brazil
Background
Covid-19 Pandemic imposed several restrictions to the general population, including stay at home guidance. Most dialysis patients are challenged by mandatory transportation and thrice-weekly long stays in their Units. Home dialysis and/or reduction of hemodialysis frequency have been promoted to mitigate the spread. Notwithstanding, we report the contrasting experience of keeping a long-term in-center short daily hemodialysis program while enforcing protective measures and an unique transportation arrangement.
Methods
From March 16, 2020 to March 15, 2022 dialysis patients who were symptomatic, hospitalized for other reasons or had contact with confirmed cases of Covid-19 were tested for Sars-Cov-2 by RT-PCR. We examined outcomes of those who tested positive. Eighty private-insured patients (48M; 62.1±14.3yrs) on in-center short daily hemodialysis (6-7x/wk; 115.4±11.2min; single-use high-flux dialyzer) were studied. Round-trip transportation was provided by a fleet of 12 dedicated minivans. Eating during dialysis was abolished and isolation room for confirmed or suspected cases was adopted. A 3-dose vaccination started in January 2021 and covered all patients and staff members.
Results
Forty out of 80 patients (50%) contracted Covid-19 (21M; 60.2±16.8yrs) and four were reinfected. Thirty of the 44 infections were symptomatic (68%) and 14 asymptomatic (32%). Ten of the 40 infected patients were hospitalized (25%), 1 required mechanical ventilation and died, while 39 recovered well (5% fatality rate pre-vaccination, 0% post-vaccination). Over the 2 years dialysis mortality and transplantation rates were 5.6% (9/80 patients). Average dialysis frequency was 5.9 sessions/week. Our 100-member staff presented 33 Covid-19 infections.
Conclusion
During the two years of Covid-19 Pandemic we kept our in-center short daily hemodialysis schedule as usual while applied comprehensive transportation and restrictive measures. There was one death attributable to Covid-19, in sharp contrast with the death toll on dialysis population worldwide (20-30% fatality rate). This benign course may reflect a combination of strict prophylatic discipline (limiting transmission among patients and staff) with a potential inflammatory mediators removal by high-frequency high-flux hemodialysis (perhaps preventing cytokine storm).