POS-527 CONTINUUM OF CARE AMONG PARTICIPANTS OF DIALYSIS OUTCOMES REGISTRY IN INDIA DURING THE COVID-19 PANDEMIC LOCKDOWN

Abstract

Introduction: Majority of ESKD patients in India avail in centre dialysis services India imposed a nation-wide lockdown for over two months during the COVID-19 pandemic Essential healthcare services including dialysis were disrupted Patients on dialysis faced severe consequences as they as could not seek care at the health care facilities 1,2,3These disruptions have impacted the continuum of care and altered the care-seeking behaviour among dialysis patients 4,5 We monitored the care-seeking behaviour among dialysis patients enrolled in the India Dialysis Outcomes Registry during the lockdown Methods: The India dialysis outcomes registry is a nationally representative study following up 1000 ESKD patients starting dialysis across 10 Indian states The registry has established a mechanism for routine data collection on clinical, socio economic outcomes and patient reported quality of life We contacted the participants telephonically to understand the continuum of care during the lockdown Efforts were directed to describe reasons for missing dialysis session(s) and document any complications due to disruptions to the dialysis services Results: We followed-up 526 participants at 9 dialysis centres after the onset of the Pandemic in India, 149 (28)% were not contactable after 3 attempts 377 participants (61% males and 39% females) consented and participated in the telephonic survey Of these, 270 (72 %) were continuing on hemodialysis, 83 (22%) died, 7 (2%) switched to Peritoneal Dialysis, while 3 % (12) had either received or were awaiting kidney transplant and 5(1%) had stopped dialysis During the interviews, 31 (8 %) reported having missed prescribed dialysis sessions ranging from one missed session to 24 missed sessions The reasons being, travel ban on account of the COVID-19 pandemic (68%), financial challenges (19%), transfer to another site (3%) and other reasons (29%) like hike in dialysis cost during pandemic, non-availability of dialysis sessions as facilities were designated as COVID-19 management units, absence of dialysis facilities in COVID-19 wards and non-availability of dialysis staff as they were quarantined (Figure 1) Out of those continuing dialysis, 15% reported being hospitalized during the pandemic They were admitted due to poor vascular access (61%), infections (29%) and 8 patients reported testing positive for COVID-19 Other reasons for hospitalizations were cardiovascular complications and stroke (Figure 2) Conclusions: The disruption to continuum of care for patients on dialysis due to travel restrictions during COVID-19 lockdown, not only resulted in difficulty in accessing the dialysis care but also contributed to worsening of their overall health Our study also elicits patient’s experiences and their perspectives on the challenges faced by them during the lockdown They identified lack of clear communications by health facilities, lack of adequate dialysis treatment facilities and non-availability of staff at dialysis units The India Dialysis Registry helped understand the disruptions in continuity of services among a representative population across the country during the COVID19 pandemic, this iterates the significance of establishing disease registries to monitor outcomes longitudinally Insights as gained from our registry will be critical to inform policy makers in time and thereby address gaps in health delivery systems in India Conflict of Interest: OJ is recipient of a UIPA scholarship from University of New South Wales, Sydney