BALANCING THE COVID-19 PANDEMIC IMPACT ON THE MAINTENANCE OF HAEMODIALYSIS VASCULAR ACCESS

Abstract BACKGROUND AND AIMS The new coronavirus disease, named by World Health Organization (WHO) as COVID-19 brought great challenges to patients with end-stage renal disease (ESRD). In general, ESRD patients have a higher number of comorbidities and are at risk for the severe presentation of this disease. As a lifeline of haemodialysis patients, vascular access (VA) care has a profound impact on the patient's quality of dialysis and life but the ideal management of VA during the pandemic is currently unknown. Many centres differed on their approach and referral criteria to minimize COVID-19 risk but the impact on VA and patient survival is unknown. In this multicentre retrospective cross-sectional study, we analysed the impact of the pandemic on VA maintenance in Vascular Access Centres of Nephrocare Portugal. METHOD The authors collected VA data from haemodialysis patients treated at three Vascular Access Centers of NeproCare Portugal from January 2019 to July 2021 and compared the year before and after the pandemic. RESULTS Of the 14 352 haemodilaysis patients included, with a mean age of 68 ± 14 years, 7.161 procedures were analysed. A total of 4086 endovascular procedures and 3075 surgeries were performed from January 2019 to July 2021 in the three national vascular access centres of Nephrocare. Blood flow decrease measured by the blood temperature sensor BTM_ (Blood Temperature Monitor), Fresenius Medical Care, Bad Homburg, Germany was the most frequent motive of referral to an endovascular procedure before and after the pandemic (P .221). During both waves, physical examination and clinical signs were the most affected motives of referral, followed by a rebound significantly increase (P .058). Thrombosis remained stable during the lockdown followed by a non-significant trend to increase. New vascular access creation was the most frequent motive to send a patient to surgery before and after the pandemic (P .480). Fistula and prosthesis thrombosis also didn't significantly increase as a motive of referral to a VAC (P .221 and 1.0 respectively). Angioplasty without stent followed by thrombolysis was the most frequent types of endovascular procedures before and during the pandemic without significant differences (P .430). Surgical thrombectomy followed by fistula creation were the most frequent types of surgical procedures before and during the pandemic without significant differences (P .683). During the first wave, there was a decrease in procedures without possibility to intervention (P .037) with posterior significant rebound increase. Although there was a trend to a decrease in intervention, the number and types of procedures didn't significantly change before and during the pandemic even after separating different centres. Additionally, the number of hospital admissions related to vascular access also didn't significantly change (P .368). CONCLUSION With the implementation of proactive infection control measures, it was possible to maintain proper monitoring, surveillance and VA care without significantly increasing the rate of thrombosis and minimizing related hospital admissions of haemodialysis patients.