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To protect the extreme vulnerability of
dialysis patients
, the 3 associations of providers throughout the country agreed that in suspected or confirmed cases of
Covid-19
must be
isolated and boarding schools
in a health center to receive dialysis right there while their evolution by the virus is followed.
“The objective is clear,” explains Miguel DIscépolo, president of the Confederation of Dialysis Associations of the Argentine Republic (Cadra). We must prevent this suspected or infected patient from being
infection vector
. This virus in a dialysis center is wildfire. ”
Deceased in Chaco
In
Chaco
However, this modality of care is not met: there, even though the patients are positive for Covid-19, they continue to receive renal replacement therapy in the same center where other dialysates without infection attend.
“In Resistencia, the only hospital with dialysis beds is the Perrando. There are few machines and we attend to the chronically ill on all shifts. Suspect or clinically stable Covid-19 patients stay at their homes and are taken and brought to his usual dialysis center, but on days and hours different from the rest, “explains Dr. María Elisa Flores Barro, director of Epidemiology in that province.
Alejandro Kohn Tulli is medical director of Fresenius Medical Care, a multinational specialized in chronic kidney disease based in Argentina that has, among others, a center in the city of Resistencia, where more than 200 patients are treated, i
Including the 5 insufficient kidney stones that died from Covid-19 in Chaco
.
“Dialysis to suspected or infected people in the same place where they go uninfected is not the best,” says Kohn Tulli-. But we have no choice and we do it with all the care: they come Tuesday, Thursday and Saturday, they do not cross with the rest of the patients and everything is disinfected. We clearly told the Ministry of Health of Chaco that they would have to be isolated and admitted to a health center so that they continue with their dialysis. They said they do not have beds. We also told them that we have the machines to do the procedure. But we had no response. ”
30,000 patients in the country
Fresenius and another multinational, Diaverum, make up the Renal Chamber, which, together with the Cadray, the Dialysis Association of CABA and the Province of Buenos Aires dialyze 95% of the 30,000 kidney failure patients in the country in 470 dialysis centers.
“Patients have 3 weekly sessions and must break the quarantine to continue living because dialysis replaces kidney function,” says Discépolo from the Spanish hospital in Mendoza, where he is Head of Transplants. They are delicate patients, one of the risk groups. for Covid-19 together with hypertensive, diabetic and cardiac patients. If we consider that 60 or 70 percent of kidney failure are diabetic, hypertensive or both, comorbidities are added. Mortality can be up to 25 percent”.
Triple triage
“We launched a triple triage,” continues Discépolo, who is a distant relative of the famous composer. “First, train the family to watch for any symptoms of infection; second, for an operator to take the patient’s temperature with an infrared thermometer. during the transfer and finally recheck temperature upon arrival at the dialysis center, where he also answers a questionnaire. ”
“It may happen that the patient, out of fear, masks some symptom, for example fever, taking an antipyretic,” says Kohn Tulli-. This happened in Chaco, with someone who died, but who previously infected others. In Latin America, between populations Very lacking, some hide symptoms because they fear being left without their only meal of the day, which is given to them after dialysis, or without their session. They must understand that it is important to tell the truth and that they will not lose neither the session nor the meal. ”
The new consensus indicates that if a suspicious case is identified, a “red channel for PCR is requested to speed up the diagnosis, which arrives in 12 hours in large cities,” adds Discépolo. While waiting for confirmation, the patient should be isolated and hospitalized and receive their dialysis sessions right there. “If they do not have equipment, we will take them,” emphasizes the nephrologist. Only if he overcomes the infection does he return to the dialysis center where he is usually treated.
A dangerous recommendation
Alfredo Casaliba, from the Association of Dialysis of CABA and Province of Buenos Aires, which cares for 45% of dialysis patients in the country, indicates that on April 7 the Ministry of Health recommended that patients with mild symptoms of Covid-19 – 80% of the cases- they could stay at home and go to the dialysis center to be cared for in isolation from the rest.
“We do not agree. That patient can infect other patients and health personnel,” says Casaliba. The ministry makes the recommendations, but those of us who are on the front lines are the providers. ”
The World Health Organization (WHO) seems to give experts the right: in a document dated March 17, it indicated that patients with mild symptoms should stay home, unless they suffer from any condition that requires isolation in hospital, such as for example kidney failure.
Another problem for providers “is the debt that the health system maintains with our sector,” says Carlos Mendieta, of the Renal Therapy Chamber. “Inherited from the previous administration, we suffered from underfunding due to the lack of payments and the delay in the value of benefits. With the pandemic, our supplies increased to sidereal numbers. An N 95 chinstrap cost 80 pesos and now 800. We need to protect patients and staff. Coronavirus puts everyone in check, but it affects more sectors of extreme risk and vulnerability, like dialysis patients. ”
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