Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres
Authors: Arenas Jimenez María Dolores , Méndez Angel , Furaz Karina , Botella Ana , Yetman Delfina , Cazar Ramiro , Cabana Mara Lisbet , Handel Marc , Sanchez María Luz , Delgado Margarita , Vasquez Maria Melissa , Martinez Isabel , Pereira Monica , González-Parra Emilio , Pizarro-Sánchez Maria Soledad , Garayzabal Ignacio Sanz , Rodriguez-Osorio Laura , Portoles José , Hernán David , Miranda Blanca ,   Renal Foundation’s Iñigo Álvarez de Toledo work team, Arenas Dolores , Miranda Blanca , Hernán David , Dapena Fabiola , llanos Los , Mendez Angel , Acuña Mariano , Gaitán Daniel , Guerrero Elena , llanos Los , Furaz Karina , de la flor Carlos Jose , Cordón Alfredo , Benavides Nardeth , González Alicia , Lauros Los , Botella Ana , Naranjo Javier , Zalamea Felipe , Manso Paula , Carballos Os , Lisbet Cabana Mara , Beato Laura , Burgos Marina , Carballos Os , Yetman Delfina , Fernández Jeanette , Sobrado Jose , Carneiro Damián , Caramés Cynthia , Handel Marc , Terleira Miguel , Sánchez Maria Luz , Pinos Los , Cerón Margarita Delgado , Herruzo Jose , Barbeito Javier , Olmos Los , Vasquez Maria Melissa , Juan Marta San , Engracia Santa , Nieto Luis , Cazar Ramiro , Hernández Jesús , Carrillo Jose Guerrero , Lalin Teixedal , Martinez Isabel , Rossignoli Araceli , Rosa Rosa Sanchez Hernández , Zamora Rocío , Rodriguez-Osorio Laura , Ledesma Cristina , Pérez Alicia García , Rubio Raquel Esteras , Garayzábal Ignacio Sanz , Iglesias Adriana , Pizarro-Sanchez Maria Soledad , Piña Lola , Saíco Saul Enrique Pampa , Tapia Marisol Poma , Alexandru Simona , Picasso Maria Lopez , Gonzalez-Parra Emilio , Pereira Monica , Feijoo Concepción Ferreira 
Published: April 2022

ABSTRACT

Background
The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions.

Methods
We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (&gt;45) as a marker of HD adequacy.

Results
A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (&gt;75 and &gt;85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P &lt; 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P &lt; 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt &gt; 45) was observed.

Conclusions
COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.