Safely reducing haemodialysis frequency during the COVID-19 pandemic
Michelle da Silva Lodge, Thilini Abeygunaratne, Helen Alderson, Ibrahim Ali, Nina Brown, Constantina Chrysochou, Rosie Donne, Ibi Erekosima, Philip Evans, Emma Flanagan, Simon Gray, Darren Green, Janet Hegarty, A Hyde, Philip A. Kalra, Elizabeth Lamerton, David Lewis, Rachel Middleton, David New, Robert Nipah, Dónal O’Donoghue, Edmond O’Riordan, Dimitrios Poulikakos, Francesco Rainone, Maharajan Raman, James Ritchie, Smeeta Sinha, Grahame Wood, James Tollitt
Abstract
BACKGROUND: Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. METHODS: Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. RESULTS: There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. CONCLUSIONS: Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.