- Three per cent of all in-centre haemodialysis patients have died from COVID-19
- ‘We are losing three to five people a day’ despite efforts, says specialist
- Patients still required to travel for treatment, despite being clinically extremely vulnerable
- All dialysis patients currently at priority four on vaccine list
Dialysis patients who must travel to hospital are nearly four times as likely to die of COVID-19 than those aged over 80, but so far have not been prioritised for receiving vaccination 14th
UK Renal Registry data shows that, from March to November 2020, 3.3 per cent of all in-centre haemodialysis patients have died from COVID-19 (662 deaths out of a population of 20,000). This figure compares to a death rate of approximately 0.7 per cent in all those aged over 80 and 1.8 per cent in over 90s.
Although the government classifies dialysis patients as clinically extremely vulnerable to covid-19, not all patients are able to receive dialysis at home and those receiving inpatient treatment still need to travel to dialysis clinics, either in main hospital buildings or smaller satellite clinics, three times a week.
At present the Joint Committee on Vaccine and Immunisation covid-19 vaccine prioritisation list ranks all dialysis patients at priority level four, alongside all other shielding patients and those aged over 70. Priority one covers all care home residents and staff, while priority two covers all over 80s and frontline health workers.
The Renal Association wrote to Public Health England and JCVI over the weekend to ask for a change in vaccine prioritisation but, at the time of writing, has not received a response. The fact the patients must regularly visit healthcare sites may also mean they are practically well-suited to vaccination (see box below).
One of the most ‘effective health interventions ever’
Graham Lipkin, consultant nephrologist and president of the Renal Association: “The risk of infection [for] in-centre dialysis patients are very high and their mortality is very high as they have serious illness but cannot shield like other CEV patients.” This is because they must travel to and from hospital for the dialysis.
Dr Lipkin added:” The kidney community and NHS England together have gone through every lens to try and protect this group, from COVID-19 screening to transporting these patients on their own rather than in groups, but we are losing three to five people a day. We want these patients to be brought up to the highest vaccine prioritisation group as their risk from COVID-19 is the same if not higher than people in nursing homes.”
He added the vaccine could be one of the most “effective health interventions ever” for this group as the Renal Association has estimated vaccinating between 35-50 people who are receiving inpatient dialysis “could save one life”.
A recent report, published in the journal PLOS One in October, also said the dialysis death rate is “likely higher than nursing home residents”.
Wei Shen Lim, covid-19 chair for JCVI: “The JCVI’s advice on covid-19 vaccine prioritisation was developed with the aim of preventing as many deaths as possible. As the single greatest risk of death from covid-19 is older age, prioritisation is primarily based on age.
“It is estimated that vaccinating everyone in the priority groups would prevent around 99 per cent of deaths from covid-19”.
An NHS spokesperson said: “Renal networks support co-ordination of care for patients who need access to dialysis either in hospitals or in dedicated facilities, and COVID-19 is also a cause of higher need for certain renal services. National guidance was published with [National Institute for Health and Care Excellence] and each area has policies in place to ensure infection control measures cover travel to units and the care delivered in the unit.”
Transplants and staffing
High rates of dialysis infections are also affecting kidney transplants and staffing. Whenever there is an infection in a dialysis day unit, which often treat at least 16 patients at a time, all the patients in it must be suspended from the transplant list for a fortnight until they have tested negative. The specialist dialysis nurses will also have to self-isolate.
Fiona Loud, policy director at the charity Kidney Care UK, said: “There are hundreds of people on dialysis who are of working age with families to support and they need to be vaccinated now. This is a chance to prevent unnecessary deaths in a group who cannot shield fully as they must go into hospital three times a week; the frequency of treatments therefore makes it easy to vaccinate them.
“While age is a major predictor of risk, a look at the evidence sadly shows that end stage kidney disease carries such an extremely high risk.
“Vaccinating dialysis patients now is a practical, humane intervention — we are asking the JCVI and PHE to stop people on dialysis dying unnecessarily.”