Hemodialysis delivered twice weekly rather than the standard regimen of thrice weekly should be considered as an option to protect patients with kidney failure from COVID-19, according to recent editorial in the Journal of the American Society of Nephrology.
Timothy W. Meyer, MD, of Stanford University School of Medicine and Palo Alto Veterans Affairs Administration Medical Center, and coauthors contend that this approach could result in less exposure to COVID-19, reduction in dialysis staff work, greater spacing of patients, decreased transportation requirements, and conservation of personal protective equipment.
“A shift of patients to less frequent hemodialysis schedules will not relieve all of the pressures that dialysis units face during this pandemic, but it should be considered as one option and would likely provide adequate control of uremia, at least over a matter of weeks.”
Collectively, the data from studies looking at outcomes of twice-weekly versus thrice-weekly hemodialysis “suggest that twice-weekly treatment is less dangerous than commonly supposed,” they wrote.
In an accompanying counterpoint editorial, Rajnish Mehrotra, MD, of the Kidney Research Institute at the University of Washington at Seattle, argued that the data comparing outcomes with twice- and thrice-weekly HD “are extremely limited and simply insufficient” to conclude that the regimens are equivalent.
“I respectfully submit that this approach could be counterproductive and could result in increasing risk to the health and welfare of patients with resultant increasing—rather than decreasing—health care utilization,” Dr Mehrotra wrote. “As such, I think it would be prudent for us to exhaust other alternatives before considering twice-weekly hemodialysis.”
As of April 26, the US had 954,182 confirmed cases of COVID-19 and 54,573 related deaths, according to the Johns Hopkins Coronavirus Resource Center in Baltimore. The governors of most states have imposed measures to stop person-to-person transmission, including shutting down nonessential businesses, ordering residents to stay at home unless leaving is essential, and urging social distancing behavior. The Centers for Disease Control and Prevention, the American Society of Nephrology, and other organizations have issued infection-control recommendations specific to the dialysis population, which are at particularly high risk of contracting SARS-CoV-2, the novel coronavirus that causes COVID-19 and experiencing severe complications from the disease. These recommendations focus on such precautions as proper use of personal protective equipment, hand washing, screening patients and visitors, and isolating infected patients.
Meyer TW, Hostetter TH, Watnick S. Twice-weekly hemodialysis is an option for many patients in times of dialysis unit stress [published online April 16, 2020] . J Am Soc Nephrol. doi: 10.1681/ASN.2020030361
Mehrotra R. Counterpoint: Twice-weekly hemodialysis should be an approach of last resort even in times of dialysis unit stress [published online April 16, 2020]. J Am Soc Nephrol. doi: 10.1681/ASN.2020040412