Despite improved protection from infection, home dialysis still faces COVID-19 challenges
Although patients receiving home dialysis may have an advantage in limiting their exposure to COVID-19, challenges have remained for them during the pandemic, a published review suggests.
“Patients who receive hemodialysis in the in-center setting have been significantly affected by the COVID-19 pandemic because of the specific logistics involved (need to travel to their dialysis units and receive dialysis in a communal setting, typically three times a week), thus increasing their risk of exposure,” wrote Preethi Yerram, MD, MS, FASN, and Madhukar Misra, MD, both from the division of nephrology at the University of Missouri, Columbia.
“Although patients on home dialysis are usually able to avoid such exposure, they face their own unique challenges.”
According to data from the Kidney Community Emergency Response, there were 6,592 patients on dialysis in the United States who tested positive for COVID-19 in April 2020; 86 patients were on home dialysis and doing self-monitoring at that time.
Due to the more intense effort at protecting patients on in-center dialysis from COVID-19, patients dialyzing at home may not see the full attention from home staff.
“Some of the challenges patients may face at home include difficulty in obtaining dialysis supplies due to strained supply chains, administration of injectable medications and timely lab draws,” the authors wrote. “It may also be challenging for these patients to obtain advice on access and technical issues, in addition to having a perception of lack of support in emergencies, resulting in avoidance of dialysis/reduced frequency of dialysis.
“Mental health issues arising from social isolation and anxiety related to perceived increased vulnerability are other potential concerns.”
These issues are resolvable, Yerram and Misra wrote, and dialysis providers should make efforts to keep home patients in place, where they are more comfortable. Some help has been offered by the International Society for Peritoneal Dialysis and the U.K. Renal Association, which have issued guidelines for management of patients on peritoneal dialysis during the COVID-19 pandemic.
Likewise, the availability of telehealth and Medicare coverage for the visits give staff an opportunity to monitor patients more closely at home.
“Remote monitoring of patients on home dialysis in conjunction with telehealth visits, and frequent contact with patients by nursing staff, can help detect potential issues quickly,” the authors wrote. “By this method, most issues can be resolved while patients remain at home, thereby reducing the need for face-to-face visits.”
The advantages of home dialysis during the COVID-19 outbreak outweigh the technical issues involving patient care, Yerram and Misra wrote, and the tools are available to resolve any management and clinical-related issues. Telehealth, in particular, is an important part of the picture.
“Going forward, virtual platforms will be required to adhere to stringent privacy regulations,” the wrote. “However, in the current relatively relaxed regulatory environment, this pandemic offers us a unique model for testing the provision of home dialysis via remote technology. Our learning experience from this pandemic will continue to help us identify hitherto unknown barriers for telehealth in this population, underscoring the aphorism that every cloud has a silver lining.”