MO892DIALYSIS SERVICE MANAGEMENT DURING COVID-19 PANDEMIC IN EUROPEAN CITY AREA

Abstract

Abstract Background and Aims Many countries across Europe experience the second wave of CoVid-19 pandemic. Lithuania is a country situated on the eastern shore of the Baltic Sea. Until January 15, Lithuania had 165560 confirmed positive cases, 100495 recoveries, and 2376 deaths. Method In this abstract, we describe reorganization in dialysis service in Vilnius, the capital and largest city of Lithuania, with urban population of 700,275 inhabitants. Results At the pandemic start in March 2020, Vilnius had 3 public nephrology departments each running a hemodialysis unit, and 4 private hemodialysis centers, with total of 250 end-stage kidney disease patients. Vilnius University Hospital Santaros Klinikos, as the main hospital in the country and national CoVid-19 coordinator, restructured dialysis service in city area. Chronic hemodialysis programs in public hospitals were cancelled and patients were shifted to private centers. In the threat of infection and multiple outbreaks in two hospitals, nephrology units were closed and CoVid-19 negative nephrology patients were located in a satellite hospital in other city, whilst all city hospitals served as CoVid-19 centers. In Santaros Klinikos, we treated severe CoVid-19 patients who needed chronic or acute dialysis, while asymptomatic and mild to moderate-symptom patients carried their dialysis procedures in isolated shafts and/or facilities in private centers. In cases with unsatisfactory self-isolation, isolation sites were located in hotels or other premises provided by the municipal administration. Transportation to dialysis center was provided by municipality as well. Rapid antigen testing was set in a case of suspected outbreak or for all outpatient hemodialysis patients in some centers in circumstances of high community transmission. During the pandemic, we had ongoing transplant activities, continued wait-listing for kidney transplant and increased peritoneal dialysis program. Most peritoneal dialysis patients were trained at home by a mobile nurse team, also home visits we carried instead of inpatients visits. We started CoVid-19 vaccination during the first week of January for all dialysis patients and transplant recipients who had no contraindications and gave informed consent. Conclusion In conclusion, the rapid release and adoption of recommendations and action plan helped to identify and locate CoVid-19 outbreaks in dialysis facilities. Dialysis service reorganization is needed to maintain ongoing treatment for chronic patients who vitally depend on renal replacement therapy. Private dialysis centers and municipality should assist with physical resources operating the patients flow. The growth of peritoneal dialysis program serves as a significant subsidiary factor when patients need more social distancing. Vaccination data and outcomes in end-stage renal disease patients is coming soon.