The management of medical care with dialysis methods in outpatients during the COVID-19 pandemic

Abstract

Introduction: The COVID-19 pandemic has changed the health care system for patients with CKD5. Dialysis patients are at particularly high risk of COVID-19, severe infection, and poor outcomes. Materials and methods: In 2020, in 86 FME RF clinics, 11 331 patients (54.1% – men) received dialysis treatment, 21.8% had DM, 10 717 patients were treated with HD and HDF methods, 614 patients were on PD, and 2854 employees provided medical care. The data were collected using the EuCliD database and statistically processed online at sites https://molbiol.kirov.ru and https://medstatistic.ru. Results: COVID-19 is more often detected in men, patients 40 to 79 y.o., in patients with DM. The rate of sick patients <50 y.o. (31.2% of all treated) was 22.8% of all infected and in the group>50 y.o. (68.8% of all treated), the rate of patients was 77.2%. There were no significant differences between the incidence of COVID-19 infection in groups ≥50 and <60 y.o., ≥60 and <70 y.o., ≥70 and <80 y.o., ≥80 y.o. COVID-19 positive patients (on HD and PD) who died in 2020 – 324 people, were 2.9% of all treated in 2020 and 31.6% of all infected dialysis patients. In FME RF clinics 18.6% and 18.4% of all patients in the RF were treated by HD and PD respectively, but the proportion of mortality from COVID-19 in FME RF clinics was 10.5% at HD and 11.0% at PD respectively. In dialysis centers, FME RF patients with COVID-19 on HD were 2.2 times less than in the dialysis population of RF as a whole (p<0.001), and on PD – 1.98 times less than in RF (p<0.001). In RF patients with COVID-19 on PD and HD, it was found that the mortality rate was significantly lower in patients on PD vs HD (p<0.001). There was no significant effect on the outcomes in COVID-19 patients depending on the method of treatment in FME RF clinics (p=0.349). Conclusion: Patients on dialysis are at greater risk of COVID-19 and fatal outcomes. The administrative, organizational, and medical work of FME RF led to positive results both in the prevention of infection and in treatment outcomes. © 2022 JSC Vidal Rus. All rights reserved.