The Adverse Effect of COVID Pandemic on the Care of Patients With Kidney Diseases in India

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected the care of patients with noncommunicable diseases, including those suffering from kidney-related ailments. Many parts of the world, including India, adopted lockdown to curb community transmission of disease. The lockdown affected transportation, access to health care facilities, and availability of medicines and consumables as well as outpatient and inpatient services. We aimed to analyze the effect of lockdown imposed due to the COVID-19 pandemic on the care of patients with kidney diseases in India. Methods: We surveyed 19 major hospitals (8 in the public and 11 in the private sector) to determine the effect of lockdown on the care of patients with kidney disease, including those on dialysis after the first 3 weeks of lockdown. Results: The total number of dialysis patients in these centers came down from 2517 to 2404. Approximately 710 (28.2%) patients missed 1 or more dialysis sessions, 69 (2.74%) required emergency dialysis sessions, 104 (4.13%) stopped reporting for dialysis, and 9 (0.36%) were confirmed to have died. Outpatient attendance in the surveyed hospital came down by 92.3%, and inpatient service reduced by 61%. Tele-consultation was started but was accessed by only a small number of patients. Conclusion: Lack of preparedness before lockdown resulted in an interruption in health care services and posed an immediate adverse effect on the outcome of dialysis patients and patients with kidney disease in India. The long-term impact on the health of patients with less severe forms of kidney disease remains unknown.

Clinical Characteristics and Short-Term Outcomes of Chronic Dialysis Patients Admitted for COVID-19 in Metro Manila, Philippines

“…Outpatient consults were reduced by 92.3%, while inpatient service decreased by 61%. 6 Given the high rate of infectivity of COVID-19, the challenge of “social distancing” and the increased risk of mortality among elderly and those with comorbidities such as chronic kidney disease, it seems prudent to pay particular attention to this vulnerable population.…”

Current Scenario of COVID-19 Related Activities in Tertiary Care Hospital of Gwalior

“…This caused fear among the staff, leading to absenteeism. 6 As the COVID-19 pandemic spread, it became increasingly evident that routine outpatient face-to-face appointments would have to be reorganized to reduce the burden on hospital resources and the infection risk that COVID-19 poses to patients. 7…”

Ethics of kidney care in the era of COVID-19

“…Surges in dialysis demand have been reported during the pandemic as a result of COVID-19-related AKI; there may also be difficulties in meeting regular demand for dialysis as a result of disruption to domestic and international supply chains. 5,6,26,27 For example, there may be staff shortages because of illness or isolation measures, people may be unable to travel safely to access dialysis during lockdown periods, medical products such as dialysate fluid may be unavailable because of transport delays or diversion of supplies to meet urgent needs elsewhere, and insufficient supplies of personal protective equipment may limit the ability of clinics to provide full services while meeting infection control standards. 26,28 Home dialysis patients may face difficulties in accessing telemedicine, laboratory services, prescriptions, and delivery of dialysis supplies.…”

“…5,6,26,27 For example, there may be staff shortages because of illness or isolation measures, people may be unable to travel safely to access dialysis during lockdown periods, medical products such as dialysate fluid may be unavailable because of transport delays or diversion of supplies to meet urgent needs elsewhere, and insufficient supplies of personal protective equipment may limit the ability of clinics to provide full services while meeting infection control standards. 26,28 Home dialysis patients may face difficulties in accessing telemedicine, laboratory services, prescriptions, and delivery of dialysis supplies. 29 Although some countries, especially low-and middleincome countries have experience with rationing of publicly funded dialysis, 30,31 rationing of dialysis in the context of the COVID-19 pandemic may present unfamiliar challenges for many health systems.…”

“…5,6,26.27 For example, there may be staff shortages due to illness or isolation measures, people may be unable to travel safely to access dialysis during lockdown periods, medical products such as dialysate fluid may be unavailable due to transport delays or diversion of supplies to meet urgent needs elsewhere, and insufficient supplies of PPE may limit the ability of clinics to provide full services while meeting infection control standards. 26 , 28 Home dialysis patients may face difficulties in accessing telemedicine, laboratory services, prescriptions, and delivery of dialysis supplies. 29 …”