Hemodialysis in the Setting of Covid – 19 Pandemic Infection

Patients on hemodialysis therapy are high-risk group for developing severe respiratory complications that may even cause death due to Corona Virus Disease 2019 (COVID-19).  They also face problems like difficulty in reaching the Dialysis Centre in the lock-down scenario, financial difficulties due to loss of income in the family, non-availability of caretakers, etc.

Dialysis facilities and professional caring to these patients must be prepared to safely manage them and protect non-infected patients and staff from acquiring the infection.  Dialysis patients are instructed to follow the below listed precautionary measures strictly

1. To come for dialysis by private transport.
2. To avoid travel and stay safe strictly at home as per Government orders.
3. To avoid contact with family members or friends who have traveled abroad or who have symptoms of fever, cough, loose stools, or breathing difficulty.
4. To strictly avoid social and religious gatherings.
5. To follow social distancing.
6. To avoid handshakes and hugs.

Patients with symptoms those who have travelled to endemic areas, or those who have had contact with persons infected with COVID-19,are asked to call ahead to Dialysis Facility to anticipate their arrival and also they should give details in the entry to dialysis unit regarding the symptoms related to COVID-19.  Patients are instructed to wear face mask (preferably from the time they leave their home) and follow social distancing in the hospital premises and in dialysis unit. Patient has to wear face mask properly.  They have to carry tissues and cover nose and mouth while coughing or sneezing, and discard tissues in appropriate container with lead. 

Those patients who are suspected or having confirmed COVID-19 will be taken up for hemodialysis in separate rooms or in the Dialysis Centre as advised by the Government. These patients may be taken up in the designated isolation shift probably in the end of the day shift so that it will avoid shift turnover time pressure and allow careful terminal station disinfection.   In a situation where the patient has to be taken along with regular patients, they will be treated in corner or end of the station with at least 6 feet distance between each other.

Staff attending suspected or infected COVID-19 patients will be having isolation gowns, gloves, masks, and high protection with shields or goggles.  Patients are advised to cooperate with dialysis staff for the sake of their own safety as well as other patients.

Patients should be aware that in the pandemic situations there are possibilities of deficiencies in the manufacturing of raw materials, transport issues, and hence shortage as well as delay in delivery of dialysis tools and medications including heparin. In such extraordinary situations, patients have to be prepared for a reduction in frequency and duration of hemodialysis sessions with reasonable underlying risks understood.

PERITONEAL DIALYSIS IN THE SETTING OF COVID-19 PANDEMIC INFECTION

Patients on peritoneal dialysis are dependent on continuous supply of dialysis bags. In pandemic situation as mentioned above closing of manufacturing units, problems related to transport and delivery can result in short supply. Thereby, peritoneal dialysis patients are expected to have adequate stock of bags. In case of non availability of stock, they have to undergo hemodialysis therapy until the supply chain is restored. Also disposal of used bags in covid-19 infected patient should be done appropriately as per recommendations.