The Impact of COVID-19 Infection Control Measures on End-Stage Renal Disease Patients in a Community Hemodialysis Setting

INTRODUCTION

Several non-pharmaceutical infection control measures have been implemented at community-based hemodialysis centers to reduce the risk of Coronavirus Disease of 2019 (COVID-19) transmission, caused by the SARS-CoV-2 virus. However, there have been concerns that such measures may disrupt the routine and timely care required by patients, with adverse effects on their health outcomes. This cross-sectional study aims to determine the unintended consequences of COVID-19 infection control measures on hemodialysis patients.

METHODS

 Electronic medical records were extracted from patients enrolled in community-based hemodialysis centers in Singapore. A baseline group prior of patients consisted of those enrolled in 2017, which was three years prior to the SARS-CoV-2-related pandemic (n = 548). This was compared with the study group of patients enrolled in 2019 (n = 426), just before the COVID-19 pandemic started. Medical records for these two groups were extracted from January to July 2018 for the baseline group and from January to July 2020, respectively. Three regression models were built to study dialysis adherence, kidney disease biomarkers, and hospitalization episodes.

RESULTS

 There was no statistically significant difference in hospitalization and mortality outcomes, adherence to dialysis management, laboratory results for dialysis-related clearance, and anemia outcomes. There was a higher proportion of patients hospitalized for vascular access-related reasons in the study group as compared to the baseline group (OR 1.6, 95% CI: 1.10 to 2.29, P = 0.014). Patients in the study group had albumin levels 2.13% higher (95% CI: 0.88 to 3.39, P < 0.001) and alkaline phosphatase levels 7.3% lower (95% CI: 1.17 to 13.02, P = 0.020) than those in the baseline group.

CONCLUSIONS

 From this community-based hemodialysis study in Singapore, it was shown that the COVID-19 pandemic did not disrupt regular healthcare services for these patients. With strategies instituted for a coordinated health delivery workflow, ensuring sufficient capacity in the various healthcare delivery sites and overall pandemic preparedness, the patient clinical outcomes measures continued to be met with no adverse consequences noted. Some improvements in dialysis-related laboratory values and quality of care targets may be due to more stringent measures instituted to protect these vulnerable patients in the community.

Violence in Sudan: A Looming Public Health Disaster

Sudan's ongoing conflict, rooted in colonial-era policies and resource competition, has led to widespread displacement, poverty, and social service breakdowns. The escalating power struggle between the Sudanese Army Forces (SAF) and the paramilitary Rapid Support Forces (RSF) exacerbates the humanitarian crisis by severely undermining the nation's health services and infrastructure. This leads to long-lasting social and economic consequences, creating a need for a coordinated response from national and international organizations to provide emergency healthcare, rebuild infrastructure, and train and retain healthcare workers. Moreover, the recent takeover of a National Public Health Laboratory in Khartoum, which contains dangerous biological material, is considered extremely dangerous. The expulsion of technicians and power cuts prevent the proper management of biological materials (e.g., polio, measles, and cholera isolates). This editorial sheds light on the deep-seated repercussions of the conflict in Sudan, with a specific focus on the toll it takes on health services and infrastructure. It calls for an all-encompassing, synergistic approach that places the health and welfare of impacted communities at the forefront. Through concerted collaboration between national entities and the global community, there lies the potential to pave the way for recuperation, fortitude, and enduring stability in regions ravaged by conflict.