Special Considerations for Patients on Home Dialysis

Special Considerations for Patients on Home Dialysis
Updated June 3, 2020
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Dialysis is a lifesaving therapy and patients should not miss treatments. Facilities should ensure that home dialysis patients have all the supplies they need to continue their dialysis treatments and should work with suppliers to understand if shortages are anticipated in items such as peritoneal dialysis fluid. Shortages of personal protective equipment are possible. Facilities should develop contingency plans for home dialysis patients to preserve supplies. For example, patients may need to reuse face masks during dialysis access care for several days instead of discarding after each use.

Facilities should coordinate with home dialysis supply companies to ensure supplies continue to be delivered to patient homes and stored appropriately. Contactless delivery might be impractical due to the size and weight of supplies. Home programs should have a plan to enable safe in-home deliveries, even if someone in the household has tested positive for COVID-19 or has symptoms consistent with COVID-19.

Risk

Patients on dialysis, including home dialysis patients, may be at higher risk for more severe disease from SARS-CoV-2, the virus that causes COVID-19. Facilities should educate patients on measures to prevent COVID-19, including frequent hand hygiene, respiratory hygiene, cough etiquette, the importance of cloth face coverings for universal source control and social distancing.

To reduce potential exposures to people with COVID-19, there may need to be changes in how the routine follow-up of home dialysis patients is conducted.

Patient Management

Facilities providing care to these patients should consider use of telehealth and other remote methods of care, such as by telephone or secure text monitoring/messaging.

Facilities should have procedures in place to evaluate patients for fever and COVID-19 symptoms prior to the patient’s arrival for appointments. If fever or symptoms are present, the patient may need to be referred to a higher level of care based on their symptoms or asked to postpone their visit to the facility.

In addition, facilities should advise their home dialysis patients to:

    • Be familiar with ways to protect themselves and their family from COVID-19. Don’t allow visitors and attempt to stay home as much as possible. If they must go out, counsel them about cloth face coverings, frequent hand hygiene and social distancing.
    • Contact their healthcare providers to ask about the need for extra medications and supplies to continue treatments.
    • Know how to contact their dialysis facility and care providers for advice.
    • Know the symptoms of COVID-19. Patients should know what to do if they develop fever or other symptoms consistent with COVID-19, including to seek care immediately for concerning symptoms like difficulty breathing.
    • Discuss their plans for staying in touch by phone or email with friends and loved ones.
    • Determine who can help with treatments if caregivers become sick.