The challenge of covid in the management of vascular access for hemodialysis in an universitary hospital

Abstract

ABSTRACT Objectives: Chronic kidney disease prevalence has been increasing worldwide. This brings the need to deliver an effective treatment, ideally through the creation of a vascular access. During the first months of the coronavirus disease 2019 (COVID-19) pandemic healthcare systems around the world were under stress, potentially affecting the creation of vascular accesses. Therefore, the aim of this study is to report a single center experience with arteriovenous fistula (AVF) creation with the primary outcomes measured being the number of days between referral, consultation and surgery while also evaluating the impact of COVID-19 on these. Methods: Procedures for AVF creation in a tertiary hospital between March 2017 and December 2020 were included in this study and their case records were retrospectively analysed and their data retrieved, including information regarding demographics, medical comorbidities, pre and post-surgical details. Results: A total of 582 procedures were performed in the analyzed period and a total of 568 accesses were created (506 being made pre-COVID and 62 post-COVID). Regarding patients' characteristics, the groups were similar except for history of stroke (p=0,044). The period between the referral to the actual vascular surgery consultation was significantly longer for the COVID group [18 (23) days vs 28 (44) days; p<0,001] while the period between the consultation to the actual surgery was significantly shorter [76 (77) days vs 40 (57) days; p<0,001]. This resulted in significantly less time between referral to surgery in the COVID group [103 (77) days vs 88 (55) days; p=0,008]. There was not a significant difference between the two groups regarding the period between the surgery to the first postsurgical evaluation [35 (38) days vs 43 (32) days; p=0,150]. The global rate of working access was 75,4% (n=428) and 49,8% (n=213) of these were effectively canulated. The difference between the working rate of pre-COVID (76,3%; n=386) and post-COVID (67,7%; n=42) groups was also statistically significant (p=0,004). Conclusion: The ability of hospitals to adapt their resources to respond to non-COVID patients was paramount to mitigate its impact. In the institution where the study took place, the time from referral to consultation was increased significantly during the first months of COVID but the time from consultation to surgery was significantly reduced. Overall, these results show that despite the overwhelming number of COVID patients, there was a successful effort to expedite the creation of a venous vascular access.