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

Abstract

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.

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

“…Lack of transportation, staff shortages and possibly personal fear or symptoms may have contributed to missed treatments in up to half of the surveyed facilities in Africa, Latin America, Middle East, South East Asia and South Asia 43 . Mortality among infected and hospitalized patients receiving dialysis exceeded 50% in most regions of the world 45 . The pivot to home modalities was not feasible in many environments that were already strained.…”

Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients

“…In addition, these patients present a high case fatality rate of over 20%( 6 ) which is more than 40% in hospitalized patients. ( 5 ) These rates are much higher than those reported in the general population. ( 2 , 3 )…”

“…A recent study( 5 ) reported that the global prevalence of COVID-19 in patients on dialysis varies between 0% and 37%, with a hospitalization rate of between 35% and 88%, with admissions to intensive care units ranging from 2% to 70%. In addition, these patients present a high case fatality rate of over 20%( 6 ) which is more than 40% in hospitalized patients.…”

Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network

“…Their impaired immunity and high burden of comorbid diseases puts them at increased risk of death and severe complications from COVID-19. [1][2][3][4][5][6] To reduce transmission of COVID-19, public health agencies quickly mandated physical distancing and self-isolation measures 7 . However, patients receiving in-center hemodialysis cannot self-isolate: uniquely, they must come to the center three times weekly for life-saving treatments which can last several hours 8 , resulting in unavoidable and regular exposure to health-care workers and other patients.…”