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A Unified Citywide Dashboard for Allocation and Scheduling Dialysis for COVID-19 Patients on Maintenance Hemodialysis
Viswanath Billa1,2, Santosh Noronha3, Shrirang Bichu1,2
1Division of Nephrology, Bombay Hospital, Mumbai, Maharashtra, India.
Insights
A web portal ensured uninterrupted hemodialysis for over 1,400 COVID-19 patients with end-stage kidney disease in Mumbai. This initiative successfully connected 97% of patients to dialysis within 48 hours, reducing mortality during the pandemic.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic severely disrupted essential healthcare services, including maintenance hemodialysis for end-stage kidney disease (ESKD) patients.
- Fear of infection transmission and isolation challenges complicated care for COVID-19-positive ESKD patients in Greater Mumbai.
- Approximately 10,000 ESKD patients rely on hemodialysis across 174 centers in the region.
Purpose of the Study:
- To establish a citywide initiative ensuring uninterrupted hemodialysis for COVID-19-infected ESKD patients.
- To develop and implement a real-time, web-based portal for managing dialysis slot availability for infected patients.
- To mitigate mortality associated with delayed or denied dialysis during the pandemic.
Main Methods:
- Designation of specialized COVID-positive, COVID-suspect, and COVID-negative hemodialysis centers by the Municipal Corporation of Greater Mumbai (MCGM).
- Development of a web-based portal by nephrologists and engineers to track and display real-time dialysis slot availability.
- Enrollment of COVID-positive ESKD patients onto the portal for facilitated access to care.
Main Results:
- The portal, operational from May 20, 2020, enrolled 1,418 COVID-positive ESKD patients by December 31, 2020.
- 97% of enrolled patients secured a dialysis slot within 48 hours, significantly improving access to care.
- Outcomes data showed 960 recoveries, 370 deaths (27%), and 88 active infections among enrolled patients.
Conclusions:
- The portal facilitated timely transfers and access to dialysis for COVID-19-positive ESKD patients, averting dialysis-related mortality.
- The initiative provided valuable data on the natural history and outcomes of COVID-19 in the ESKD population.
- The system aided city administration in projecting resource needs and managing the pandemic's impact on chronic care.
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic has caused significant global disruption, especially for chronic care like hemodialysis treatments. Approximately 10,000 end-stage kidney disease (ESKD) patients are receiving maintenance hemodialysis (MHD) at 174 dialysis centers in Greater Mumbai. Because of the fear of transmission of infection and inability to isolate patients in dialysis centers, chronic hemodialysis care was disrupted for COVID-19-infected patients. Hence, we embarked on a citywide initiative to ensure uninterrupted dialysis for these patients.
Materials And Methods:
The Municipal Corporation of Greater Mumbai (MCGM) designated 23 hemodialysis facilities as COVID-positive centers, two as COVID-suspect centers, and the rest continued as COVID-negative centers to avoid transmission of infection and continuation of chronic hemodialysis treatment. Nephrologists and engineers of the city developed a web-based-portal so that information about the availability of dialysis slots for COVID-infected patients was easily available in real time to all those providing care to chronic hemodialysis patients.
Results:
The portal became operational on May 20, 2020, and as of December 31, 2020, has enrolled 1,418 COVID-positive ESKD patients. This initiative has helped 97% of enrolled COVID-infected ESKD patients to secure a dialysis slot within 48 hours. The portal also tracked outcomes and as of December 31, 2020, 370 (27%) patients died, 960 patients recovered, and 88 patients still had an active infection.
Conclusions:
The portal aided the timely and smooth transfer of COVID-19-positive ESKD patients to designated facilities, thus averting mortality arising from delayed or denied dialysis. Additionally, the portal also documented the natural history of the COVID-19 pandemic in the city and provided information on the overall incidence and outcomes. This aided the city administration in the projected resource needs to handle the pandemic.
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