Keeping the vascular access alive during the COVID-19 pandemic

Background: Delay in care of suspected stenosis or thrombosis can increase the chance of losing hemodialysis access. Many procedures were canceled or postponed at the start of the COVID-19 pandemic. We have done a study to determine if the COVID-19 pandemic affected dialysis access care. Methods: We performed a retrospective chart review to evaluate the incidence of both fistula and graft thrombectomies between April 1, 2020, and March 31, 2021, designated as the COVID-19 group and compared it with an incidence between April 1, 2019, and March 31, 2020, designated as the pre-COVID-19 group. Unsuccessful thrombectomy was defined as subsequent tunneled hemodialysis catheter placement within 48 hours after thrombectomy due to clotted access. Results: There was no significant difference in the total fistula and graft thrombectomies between the two time periods: 44 cases in the pre-COVID-19 era, the incidence rate of 0.12 per patient-year;54 cases in the COVID-19 era, the incidence rate of 0.14 per patient-year (HR=1.23, 95% CI= 0.81-1.89, p=0.31). However, there was a significant increase in the fistula thrombectomy in the COVID-19 era: 9 cases in the pre-COVID-19 era, the incidence rate of 0.024 per patient-year;21 cases in the COVID-19 era, the incidence rate of 0.057 per patient-year (HR=2.38, 95% CI= 1.03-5.88, p=0.02). In addition, the incidence of unsuccessful fistula thrombectomy also increased significantly: 2 cases in the pre-COVID-19 era, the incidence rate of 0.005 per patient-year;9 cases in the COVID-19 era, the incidence rate of 0.024 per patient-year (HR=4.54, 95% CI= 1.01-50, p=0.03). There was no significant difference in total as well as unsuccessful graft thrombectomy between the two eras. Conclusions: We noticed a significant increase in fistula thrombosis and unsuccessful fistula thrombectomy in 1-year of the COVID-19 pandemic. This could be due to a delay in referring the patients for treatment of fistula stenosis. Even though the dialysis access procedures were considered essential, there might have been hesitancy on part of patients and referring dialysis center which led to this result. However, we did not notice this trend in AV graft. Timely referral for intervention is important to prevent vascular access thrombosis and loss.