Abstract
Introduction
It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income (LLMIC) settings. We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic.
Methods
The International Society of Nephrology(ISN) and Dialysis Outcomes and Practice Patterns Study(DOPPS) conducted a global online-survey of HD units between March and November, 2020 to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons.
Results
Surveys were returned from 412 facilities in 78 countries: 15(4%) in Low Income Countries (LIC), 111(27%) in Lower-middle Income Countries (LMIC), 145(35%) in upper-middle income countries (UMIC) and 141(34%) in high-income countries (HIC). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LIC(72%) and LMICs(68%) as compared to UMIC(33%) and HIC(20%). The number of patients who missed HD treatments was reported to have increased during the COVID19 pandemic in LIC(64%) and LMIC(67%) as compared to UMIC(31%) and HICs(6%). Limited access to HD, intensive care unit (ICU) care and mechanical ventilation among hospitalized COVID-19 chronic dialysis patients was also reportedly higher in LIC and LMIC as compared to UMIC and HIC.
Conclusion
Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities which may contribute to poorer outcomes.
It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income (LLMIC) settings. We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic.
Methods
The International Society of Nephrology(ISN) and Dialysis Outcomes and Practice Patterns Study(DOPPS) conducted a global online-survey of HD units between March and November, 2020 to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons.
Results
Surveys were returned from 412 facilities in 78 countries: 15(4%) in Low Income Countries (LIC), 111(27%) in Lower-middle Income Countries (LMIC), 145(35%) in upper-middle income countries (UMIC) and 141(34%) in high-income countries (HIC). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LIC(72%) and LMICs(68%) as compared to UMIC(33%) and HIC(20%). The number of patients who missed HD treatments was reported to have increased during the COVID19 pandemic in LIC(64%) and LMIC(67%) as compared to UMIC(31%) and HICs(6%). Limited access to HD, intensive care unit (ICU) care and mechanical ventilation among hospitalized COVID-19 chronic dialysis patients was also reportedly higher in LIC and LMIC as compared to UMIC and HIC.
Conclusion
Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities which may contribute to poorer outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 971-982 |
| Number of pages | 12 |
| Journal | Kidney International Reports |
| Volume | 7 |
| Issue number | 5 |
| Early online date | 10 Mar 2022 |
| DOIs | |
| Publication status | Published - 1 May 2022 |
Bibliographical note
Funding Information:The authors thank the national society and registry countries and ISN regional board leaders who provided the lists of dialysis centers that we were then able to contact. We are grateful to Charu Malik and Paul Laffin at ISN for their support and Silvia Salaro at ISN who assisted with contacting the country leaders and deploying the survey. We are grateful to staff at Arbor Research Collaborative for Health for supporting survey development and deployment. This research has previously been reported at Kidney Week 2021 (American Society of Nephrology). BR, RPF, MG, and RP (Dialysis Outcomes and Practice Patterns Study) developed the study idea and initial questionnaire. FC, RA, EKT, GD, AL, VL, DS, CP, RE, and VJ adapted the survey. RA and FC disseminated the survey to ISN members (with the support of ISN). BB performed the analysis. EKT wrote the first draft of the manuscript, with edits by GD, RPF, VL, and BR. All authors reviewed the manuscript and approved its final draft.
Funding Information:
RPF reports receiving research grants from Fresenius Medical Care; receiving consulting fees from AstraZeneca, Bayer, Novo Nordisk, Boehringer-Lilly, and Retrophin; and conducting voluntary work for the ISN and KDIGO. VJ reports receiving grants from Baxter Healthcare, GlaxoSmithKline, NephroPlus, and Biocon; receiving honoraria from AstraZeneca and Baxter Healthcare; participating in Zydus and GlaxoSmithKline data safety monitoring boards; and is the past president of the ISN. AL is a member of ISN ExCom, a member of OSEA Regional Board, and Chair of the ISN Disaster Preparedness Working Group. BR reports receiving consultancy fees or travel reimbursement since 2019 from AstraZeneca, GlaxoSmithKline, and Kyowa Kirin Co. All the other authors declared no competing interests.
Publisher Copyright:
© 2022 International Society of Nephrology
Keywords
- advocacy
- chronic hemodialysis
- COVID-19
- inequity
- kidney failure
- nephrology
Fingerprint
Dive into the research topics of 'The COVID-19 pandemic identifies significant global inequities in hemodialysis care in Low and Lower Middle-Income countries: an ISN/DOPPS survey'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver