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Feasibility of Twice-Weekly Hemodialysis During COVID-19

Open AccessPublished:June 30, 2021DOI:https://doi.org/10.1016/j.xkme.2021.06.005
      To the Editor:
      We read with interest the research letter by Clark et al
      • Clark D.A.
      • West K.A.
      • Tennankore K.K.
      Feasibility of twice-weekly hemodialysis: contingency planning for COVID-19.
      examining the feasibility of twice-weekly hemodialysis (HD) during the COVID-19 pandemic. Using a stepwise approach, only 4% of the patients fulfilled their criteria for twice-weekly HD. Therefore, they concur that twice-weekly HD should be implemented only as a last resort.
      • Mehrotra R.
      Counterpoint: twice-weekly hemodialysis should be an approach of last resort even in times of dialysis unit stress.
      In contrast, our real-world experience suggests that twice-weekly HD is a valid option for a higher percentage of patients in this health crisis. In March 2020, patients with a baseline ultrafiltration rate <8.5 mL/kg/h were switched from 3 to 2 sessions per week at our dialysis clinic. This group comprised 16 out of 48 (33%) patients, and we compared them to 32 patients with a higher ultrafiltration rate who dialyzed 3 times a week. This prospective 6-month observational study was recently published in Hemodialysis International.

      Siga E, Elso W, Gil M, Basile H, Benegas M, Ibalo N. Reduced frequency hemodialysis in times of COVID-19: a prospective study in prevalent patients. Hemodial Int. https://doi.org/10.1111/hdi.12915

      All but 2 of the twice-weekly HD patients showed residual diuresis: 1,130 (95% CI 707-1,554) mL/day. Baseline potassium was 4.4 (4.3-4.5) mEq/L and did not change throughout the study. Notably, despite being older and having a higher baseline erythropoietin resistance index than the 3-times-weekly patients, nutrition surrogates and anemia variables did not show any major changes in the twice-weekly patients. None of the twice-weekly patients required hospitalization or emergency dialysis.
      We acknowledge that our criteria were more relaxed than those of Clark et al.
      • Clark D.A.
      • West K.A.
      • Tennankore K.K.
      Feasibility of twice-weekly hemodialysis: contingency planning for COVID-19.
      Nevertheless, our data support the notion that selected patients could be safely transferred to a twice-weekly schedule in times of dialysis unit stress.
      • Meyer T.W.
      • Hostetter T.H.
      • Watnick S.
      Twice-weekly hemodialysis is an option for many patients in times of dialysis unit stress.

      Article Information

      Financial Disclosure

      The author declares that he has no relevant financial interests.

      Peer Review

      Received April 18, 2021. Accepted April 25, 2021 after editorial review by the Editor-in-Chief.

      References

        • Clark D.A.
        • West K.A.
        • Tennankore K.K.
        Feasibility of twice-weekly hemodialysis: contingency planning for COVID-19.
        Kidney Med. 2021; 3: 314-316
        • Mehrotra R.
        Counterpoint: twice-weekly hemodialysis should be an approach of last resort even in times of dialysis unit stress.
        J Am Soc Nephrol. 2020; 31: 1143-1144
      1. Siga E, Elso W, Gil M, Basile H, Benegas M, Ibalo N. Reduced frequency hemodialysis in times of COVID-19: a prospective study in prevalent patients. Hemodial Int. https://doi.org/10.1111/hdi.12915

        • Meyer T.W.
        • Hostetter T.H.
        • Watnick S.
        Twice-weekly hemodialysis is an option for many patients in times of dialysis unit stress.
        J Am Soc Nephrol. 2020; 31: 1141-1142

      Linked Article

      • Feasibility of Twice-Weekly Hemodialysis: Contingency Planning for COVID-19
        Kidney MedicineVol. 3Issue 2
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          Patients receiving facility-based hemodialysis represent a unique and vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic. These individuals require life-sustaining treatment on average 3 times weekly at a dialysis center and cannot remain isolated at home. For each treatment, patients regularly interact with transportation workers, other dialysis patients, and members of the health care team. This places them at heightened risk for acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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