Hemodialysis Vascular access maintenance in the Covid-19 pandemic: Positioning paper from the Interventional Nephrology Committee of the Brazilian Society of Nephrology

Franco, Ricardo Portiolli; Costa, Ciro Bruno Silveira; Sousa, Clayton Santos; Rodrigues, Anderson Tavares; Neves, Precil Diego Miranda de Menezes; Chula, Domingos Candiota

doi:10.1590/2175-8239-jbn-2020-s110

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Surgical revision of malfunctioning vascular access [101] or the placement of vascular access remained an essential life-saving procedure [33,44,50,[101][102][103][104]. A local rule supposed to postpone the creation of arteriovenous fistulae for patients within six months of requiring HD [57].…”

Section: Surgical Operationsmentioning

confidence: 99%

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The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

et al. 2021

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Background Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. Methods A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. Results The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. Conclusions This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.

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Section: Surgical Operationsmentioning

confidence: 99%

“…Before vascular access surgery, patients underwent COVID-19 screening [47,67,105]. Operations on patients with confirmed or suspected COVID-19 infection were carried out in a designated room [47] if postponing the procedure was not advisable [101].…”

Section: Surgical Operationsmentioning

confidence: 99%

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

et al. 2021

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“…The potential benefit of early permanent VA has had to be weighed against the downside of potentially exposing patients to the virus and consuming valuable resources, including operating rooms, staff and personal protection equipment. However, most nephrologists believe that the procedures that guarantee AVFs or AVGs for HD patients should not be postponed [ 9 ]. No data have been published on the real effect that this measure has had on the proportion of central venous catheters (CVCs) in HD patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres

Jiménez

Delgado

Pereira

et al. 2022

Clinical Kidney Journal

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Background The COVID pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies has proposed deferring the creation of an elective vascular access (VA) (autologous or prosthetic arteriovenous fistula (AVF or AVG) in incident patients on hemodialysis (HD) in the era of a COVID pandemic. The aim of this study is to examine the impact of COVID pandemic on VA creation and the CVC-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of 3 different regions. Methods We compared retrospectively two periods of time: the pre-COVID (January 1th 2019-March 11th 2020) and the COVID era (March 12th 2020-June 30th 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centers. The variables analyzed were: type of VA (central venous catheter-CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC-HD sessions that did not reach the goal of KT(KT> 45) as marker of HD adequacy. Results 1791 VA for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during COVID period compared to those who did not were significantly younger and a significant decrease of surgical activity to create AVFs and AVGs in older HD patients (> 75 and > 85 years) was observed in COVID period compared to Pre-COVID period. There was a significant increase in CVC placement (from 59.7% to 69.5%) (p<0.001) from the pre-COVID to the COVID time-period. During COVID pandemic a significantly higher number of patients started HD through a CVC (80.3% vs. 69.1%, p<0.001) The percentage of CVC in prevalent HD patients has not decreased 19 months after the start of the pandemic (414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In COVID period a significant increase in catheter replacement and in the percentage of HD session that not reach the HD dose objective (KT> 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD with an increase of CVC relative to AVF. A decrease in HD session that not reach the HD dose objective was observed in COVID period compared to preCOVID period.

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A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic

et al. 2021

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The COVID-19 pandemic has resulted in major disruption to the delivery of both routine and urgent healthcare needs in many institutions across the globe. Vascular access (VA) for haemodalysis (HD) is considered the patient’s lifeline and its maintenance is essential for the continuation of a life saving treatment. Prior to the COVID-19 pandemic, the provision of VA for dialysis was already constrained. Throughout the pandemic, inevitably, many patients with chronic kidney disease (CKD) have not received timely intervention for VA care. This could have a detrimental impact on dialysis patient outcomes in the near future and needs to be addressed urgently. Many societies have issued prioritisation to allow rationing based on clinical risk, mainly according to estimated urgency and need for treatment. The recommendations recently proposed by the European and American Vascular Societies in the COVID-19 pandemic era regarding the triage of various vascular operations into urgent, emergent and elective are debatable. VA creation and interventions maintain the lifeline of complex HD patients, and the indication for surgery and other interventions warrants patient-specific clinical judgement and pathways. Keeping the use of central venous catheters at a minimum, with the goal of creating the right access, in the right patient, at the right time, and for the right reasons, is mandatory. These strategies may require local modifications. Risk assessments may need specific “renal pathways” to be developed rather than applying standard surgical risk stratification. In conclusion, in order to recover from the second wave of COVID-19 and prepare for further phases, the provision of the best dialysis access, including peritoneal dialysis, will require working closely with the multidisciplinary team involved in the assessment, creation, cannulation, surveillance, maintenance, and salvage of definitive access.

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Hemodialysis Vascular access maintenance in the Covid-19 pandemic: Positioning paper from the Interventional Nephrology Committee of the Brazilian Society of Nephrology

Cited by 3 publications

References 6 publications

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres

A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic

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