Vascular access management during the COVID-19 pandemic period

Abstract

Background: dialysis patients are more vulnerable to severe coronavirus disease 2019 (COVID-19) infection due to multiple comorbidities. The aim of this study was to analyze the indirect effect of the COVID-19 epidemic on the management of vascular access (VA). Methods: in this observational single-center retrospective study, we collected VA data from hemodialysis patients treated in 2019 and 2020, before and after coronavirus outbreak. Results: we updated the usual medical procedures and adapted them to this new situation in order to prevent the coronavirus disease from spreading. We analyzed 723 patients (403 from 2019 and 320 from 2020). The number of surgical interventions was similar in both periods with an increase of the number of radiocephalic fistula performed during 2020 (51.2 % vs. 32.5 %) (p = 0.026) and a reduction of the surgical waiting list (30 ± 23.2 days in 2019 vs. 15.2 ± 19.2 days in 2020 (p = 0.001). The death rate among patients from the Advance Chronic Kidney Disease clinic also increased during 2020 (37.5 % vs. 27,5 %) (p = 0.02). During the pandemic year, there was a slight non-significant increase of incident and prevalent hemodialysis patients with central venous catheter. Incident patients with catheter: 48.5 % in 2019 vs. 55.5 % in 2020 (p = 0.440). Prevalent patients with catheter: 34.8 % in 2019 vs. 40,4 % in 2020 (p = 0.380). No patient was infected with coronavirus in the first month after surgery. Conclusion: the safety of both patient and staff can be ensured by the implement of proactive infection measures without sacrificing the hemodialysis vascular access care quality.