Dialysis practices during the COVID-19 pandemic: a survey from India

Introduction: The COVID-19 pandemic has been a challenging time for dialysis units worldwide. Nephrologists are faced with the difficult task of providing renal replacement therapy to COVID-19 patients and simultaneously prevent spread of COVID-19 in dialysis units. Objectives: We aimed to study the dialysis practices being followed during the COVID-19 pandemicPatients and Methods: A questionnaire assessing treatment and preventive practices being followed in dialysis units during the COVID-19 pandemic was emailed to nephrologists and nephrology trainees practising in India. Responses were recorded electronically.Results: We received 173 valid responses. About 83.2% nephrologists were providing dialysis for COVID-19. Hemodialysis/slow low-efficient dialysis was the most common modality (65.2%) of renal replacement therapy (RRT) in COVID-19 acute kidney injury. In dialysis patients with suspicious symptoms, most common test to rule out COVID-19 was RT-PCR (reverse transcriptase polymerase chain reaction) + chest imaging ( 42.2%) followed by RT-PCR alone (34.1%). Around 80.9% nephrologists sought a negative RT-PCR in patients who had recovered from COVID-19 before discontinuation of isolation measures. Adherence to COVID-19 preventive measures varied between 15.2% (portable reverse osmosis disinfection) to 97.1% (mask wearing). Healthcare worker (HCW) training programme was present in 88.4% cases, paid leaves for COVID-19 in 89% and daily HCW symptom screen in 65.3%. The most frequently identified barrier to chronic kidney disease care was a delay in transplantation (66.5%). Accordingly, 20.8% reported a temporary closure of dialysis unit due to COVID-19 outbreak. Moreover, 63% of nephrologists counseled patients to choose peritoneal dialysis above hemodialysis as permanent RRT.Conclusion: Hemodialysis/slow low efficient dialysis is the preferred modality of RRT in COVID 19-AKI. Many nephrologists are counseling for peritoneal dialysis as superior to hemodialysis during COVID-19 for maintenance RRT. Preventive measure adherence is variable across centers. HCW safety has been addressed in most centers.