Why safe transportation and daily high-flux hemodialysis have helped save lives of dialysis patients during Covid-19 pandemic period
Comprehensive transportation and short-daily hemodialysis prevented Covid-19 deaths in the vulnerable dialysis population, a new study finds. The results were presented today at the American Society of Nephrology (ASN) Kidney Week 2022 Annual Meeting being held November 3-6, in Orlando
Orlando, FL, Nov 3, 2022 — 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 or reduction of hemodialysis frequency have been promoted to mitigate the spread. Notwithstanding, a team of nephrologists of the Centro Brasiliense de Nefrologia e Dialise (CBN&D), Brasilia, Brazil, reported the contrasting experience of keeping a long-term in-center short daily hemodialysis program while enforcing protective measures and an unique transportation arrangement.
“Confronting early guidelines regarding SARS-Cov-2 infections, we have decided to keep our DAILY IN-CENTER hemodialysis schedule - ongoing for the last 15 years - assuming the risks of doubling its adverse consequences” said Istenio Pascoal, MD, the study lead author and Administrative Director of CBN&D.
Protective transportation arrangements, rigorous preventive measures for all patients and staff members (including suspension of food intake during sessions) and frequent testing were adopted to oppose the presumable higher risks of Covid-19 spread in our daily schedule, said Luiza Lins, CBN&D Manager Nurse and study's co-author
In their study 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. The authors examined outcomes of those who tested positive. Eighty private-insured patients, median age 62 years old, on in-center short daily high-flux hemodialysis, were enroled. Round-trip transportation was provided by a fleet of 12 dedicated minivans. Eating during the two-hour course of each dialysis treatment was abolished and isolation room for confirmed or suspected cases was adopted. A 3-dose vaccination schedule was started in January 2021 and covered all patients and staff members.
“Over the two years and with three variants of the Sars-Cov-2 virus, 50% (40 out 80) of our dialysis patients contracted Covid-19 infection and four were reinfected. Thirty infected patients remained on in-center short daily high-flux hemodialysis, while 10 were hospitalized, one of them required mechanical ventilation, and finally died”, said Adolfo Simon, MD, who coauthorized the study. “On the other side, during the 2 years of Pandemic our annual mortality rate as well as our annual transplantation rate were both 5.6%, keeping the long-term good performance of our practice”
“CBN&D high-frequency high-flux hemodialysis program, in addition to having promoted metabolic and hemodynamic stability of our dialysis population, may have remarkably removed inflammatory mediators what prevented the potentially devastating cytokine storm in those Covid-19 infected patients”, said Juliane Lauar, MD, CBN&D Medical Director and the study coauthor.
Study co-authors include Kelia Xavier, MD and Vilber Belo, MD.
Contact author Dr. Istenio Pascoal: Este endereço de email está sendo protegido de spambots. Você precisa do JavaScript ativado para vê-lo.
