Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

Abstract

<b><i>Backgrounds:</i></b> The recent coronavirus disease 2019 (CO­VID-19) pandemic has placed worldwide health systems and hospitals under pressure, and so are the renal care models. This may be a unique opportunity to promote and expand alternative models of health-care delivery in patients undergoing renal replacement therapies. <b><i>Summary:</i></b> Despite the high risk of acquiring communicable diseases when undergoing in-centre treatments, only a small proportion of patients are currently being treated with home therapies. Recent data provided by the Italian Society of Nephrology (SIN), the REIN French Registry and the Wuhan Hemodialysis Quality Control Center clearly show that patients receiving hospital-based treatment have a 3- to 4-fold greater risk of infection, and a subsequent fatality proportion between 21 and 34%. On the other hand, home-based therapy can be managed remotely, there is little or no need for transport to and from the hospital, and it is less expensive. Besides, the digital revolution in health care with the development of virtual care systems can make home dialysis with telehealth a cost-effective solution for both patients and health-care providers. Such a transition would require specific training for physicians and health-care professionals and a functional re-organization of dialysis centres to improve the skills and expertise in caring for patients at home. <b><i>Conclusion:</i></b> The need for more widespread home treatment is the main lesson learnt by nephrologists by the COVID-19 pandemic.

Telehealth at scale can improve chronic disease management in the community during a pandemic: An experience at the time of COVID-19

“…During this period, people were confined at home, while hospitals and family doctors strived to manage infected people. Hence, patients with pre-existing chronic conditions were often left behind with a consequent worsening of their status and excess mortality from causes other than the COVID-19 [ 3 – 5 ].…”

Challenges Faced by the Patients on Dialysis Treatment in COVID-19 Era and the Possible Solutions

“…In case patients in ICU need dialysis; Multidisciplinary discussions by utilizing a mode of video conferencing can minimize the doctors and staff traffic to the patient's room. However, despite taking all these safety measures to protect staff and doctors-never ever compromise the safety of patients [8][9][10][11][12][13]. Other measures include home-based Dialysis, assisted home dialysis, flexibility empowerment, and home biochemical controls are the few modalities that are accepted as an alternative to hospital-based dialysis.…”

“…It requires multiple hand-on workshops with patients directly to make them adept and answer all the queries. Furthermore, telemedicine can be used to treat these patients remotely that is cost-effective, but this transition requires digital advancement and extensive training for healthcare workers along with the patients so that they can master the skills properly [9][10][11][12][13][14][15].…”

“…Technology is not available everywhere in these countries so, telemedicine and the goals it promises cannot be achieved in remote areas [10][11][12][13][14][15][16]. In a study regarding the initial impact of the COVID-19 pandemic on the dialysis patients in Renmin Hospital, Wuhan University, it was found that 37 patients on dialysis (out of 230 patients) contracted COVID-19 while 4/33 staff members caught COVID-19 infection (14th January -17th February 2020).…”

“…Additionally, such patients are having multiple comorbid conditions, endangering them further to contract the infection [4][5][6][7][8][9][10]. The pandemic has entailed an enormous burden upon the hospital management and the healthcare workers because of limited staff availability during this pandemic [11][12][13][14]. Owing to scarcity of knowledge of the SARS-CoV-2 natural history, problem of the asymptomatic carriers, international travelers, paucity of optimum treatment, risks of reinfection, and overstretched global health systems have resulted in huge challenge to tackle it and curb it effectually.…”