Throughout the COVID-19 pandemic, nephrologists have made adjustments to best care for patients. Now they are taking stock of how kidney care has changed and considering which of those changes might stick moving forward.
The challenges of delivering kidney care during the pandemic underscored the need for innovation. The experience of meeting those challenges also showed nephrologists that some improvements are well within reach and that emergency protocols adopted during the pandemic may become a new normal.
“I’ve stopped thinking that this is temporary,” says Jeffrey Perl, MD, SM, FRCP, associate professor of medicine at the University of Toronto and staff nephrologist at St. Michael’s Hospital Unity Health. Instead, he’s asking, “What are we going to do to make healthcare safer for patients on renal replacement therapy no matter what comes at us?”
Perl would like to see what he calls the “COVID-19 mentality” stick around for the foreseeable future. First and foremost, that means a sustained focus on infection control—above and beyond what was previously standard in kidney care. He and his colleagues have applied for a grant to look at the impact the pandemic has had on dialysis-related infections. “Our hope is that infections are lower because of a heightened awareness around infection prevention among patients as well as providers.”
What else has changed in kidney care?
■ Dialysis centers instituted COVID-19 screening protocols, increased their capacity to treat infectious patients, and adopted telehealth to facilitate physician visits.
■ Hospitals took steps to modify where and how they delivered dialysis, both to conserve supplies and to protect their patients and employees.
■ Kidney transplantations came to a halt at many facilities, and hospitals with the capacity to receive patients developed new immunosuppression protocols that could influence future care.
■ Home dialysis emerged as a model that is safer for patients and less vulnerable to disruption during times of pandemic.
■ And healthcare providers of all stripes—and their patients—widely embraced the use of telehealth.
At the same time, providers encountered barriers to the widespread implementation of some of these practices, which may mean they are not sustainable over time. Nevertheless, American Society of Nephrology (ASN) members appear optimistic about what lies ahead. Here’s what we learned from them about how recent changes to the status quo might inform future practice.
Goldfarb DS, et al.. Impending shortages of kidney replacement therapy for COVID-19 patients. Clin J Am Soc Nephrol 2020; 15:880–882 doi: 10.2215/CJN.05180420
Kidney Health Initiative. Accelerating technology development during a pandemic to bring more people with kidney failure home. May 8, 2020. https://khi.asn-online.org/uploads/AcceleratingHomeDialysisTechnology_KHIPositionPaper_May2020.pdf
Thomas A, et al.. The frequency of routine blood sampling and patient outcomes among maintenance hemodialysis recipients. Am J Kidney Dis 2020; 75:471–479. doi: 10.1053/j.ajkd.2019.08.016