The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey

Elliot Koranteng Tannor; Brian Bieber; Ryan Aylward; Valerie Luyckx; Dibya Singh Shah; Adrian Liew; Rhys Evans; Chimota Phiri; Murilo Guedes; Ronald Pisoni; Bruce Robinson; Fergus Caskey; Vivekanand Jha; Roberto Pecoits-Filho; Gavin Dreyer

doi:10.1016/j.ekir.2022.02.027

The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey

Kidney Int Rep. 2022 May;7(5):971-982. doi: 10.1016/j.ekir.2022.02.027. Epub 2022 Mar 11.

Authors

Elliot Koranteng Tannor¹, Brian Bieber², Ryan Aylward^{3

4}, Valerie Luyckx^{5

6

7}, Dibya Singh Shah⁸, Adrian Liew⁹, Rhys Evans¹⁰, Chimota Phiri¹¹, Murilo Guedes¹², Ronald Pisoni², Bruce Robinson², Fergus Caskey³, Vivekanand Jha^{13

14

15}, Roberto Pecoits-Filho^{2

12}, Gavin Dreyer¹⁶

Affiliations

¹ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
² Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
³ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁴ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁵ Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
⁷ University Children's Hospital, Zurich, Switzerland.
⁸ Department of Nephrology and Transplant Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
⁹ Mount Elizabeth Novena Hospital, Singapore, Singapore.
¹⁰ Department of Transplantation, Renal Medicine, University College London, Royal Free Hospital, London, UK.
¹¹ Queen Elizabeth Central Hospital, Blantyre, Malawi.
¹² Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
¹³ George Institute for Global Health, New Delhi, India.
¹⁴ School of Public Health, Imperial College, London, UK.
¹⁵ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹⁶ Department of Renal Medicine, Barts Health NHS Trust, London, UK.

Abstract

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 countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic.

Methods: The ISN and the 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 (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs-14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, 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 that may contribute to poorer outcomes.

Keywords: COVID-19; advocacy; chronic hemodialysis; inequity; kidney failure; nephrology.