INTRODUCTION: It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income (LLMIC) settings. We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic. METHODS: The International Society of Nephrology(ISN) and Dialysis Outcomes and Practice Patterns Study(DOPPS) conducted a global online-survey of HD units between March and November, 2020 to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons. RESULTS: Surveys were returned from 412 facilities in 78 countries: 15(4%) in Low Income Countries (LIC), 111(27%) in Lower-middle Income Countries (LMIC), 145(35%) in upper-middle income countries (UMIC) and 141(34%) in high-income countries (HIC). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LIC(72%) and LMICs(68%) as compared to UMIC(33%) and HIC(20%). The number of patients who missed HD treatments was reported to have increased during the COVID19 pandemic in LIC(64%) and LMIC(67%) as compared to UMIC(31%) and HICs(6%). Limited access to HD, intensive care unit (ICU) care and mechanical ventilation among hospitalized COVID-19 chronic dialysis patients was also reportedly higher in LIC and LMIC as compared to UMIC and HIC. Staff in LLMIC reported less routine testing for SARS-CoV-2 when asymptomatic as compared to UMIC and HIC - 14% in LIC and 11% in LMIC, compared to 26% and 28% in UMIC and HIC respectively. Severe shortages of PPE were reported by respondents from LIC and LMIC compared to UMIC and HIC, especially with respect to the use of the N95 particulate - air respirator masks. CONCLUSION: Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities which may contribute to poorer outcomes.
The COVID-19 pandemic identifies significant global inequities in hemodialysis care in Low and Lower Middle-Income countries - an ISN/DOPPS survey