Dialysis Patients as a Vulnerable Group

As I was considering writing this post about a “vulnerable group” I looked no further than my current clinical setting in Nephrology and decided to speak about Chronic Kidney Disease (CKD) patients undergoing dialysis. CKD patients exhibit in increased cardiovascular risk and therefore renders them as a “vulnerable population” (Schlieper et al., 2015). Based on data from the U.S., coronary artery disease is the most prevalent cause of mortality, and CKD patients who are receiving dialysis commonly die due to sudden cardiac related complications (Schliper et., 2015). Dialysis patients also have weaker immune systems which increase their risk for infections (CDC, 2022). In the face of the Covid-19 pandemic, dialysis patients are unable to self-isolate and must go to treatment centres such as covid-stricken hospitals to receive dialysis 3x/week.

Dialysis patients also have challenges in continuity of care when they are frequently admitted due to the nature of their disease and health challenges. More specifically, dialysis patients have complex health care needs that may not be accurately reflected in care transfers/discharges which can result in potential medical errors and adverse events (Harel et al., 2012). This information is one and the same when I compare it to the renal setting I work in, and the risks and challenges that I see with the dialysis patient population. Even when looking within the dialysis population, there are further disparities such as limited access to renal replacement treatment for populations that are of low socio-economic status, ethnic minorities, and Indigenous communities (Erdmann et al., 2020).

There are solutions to serving the dialysis population to provide more holistic and effective care which can minimize their vulnerability to the mentioned risks. Transitioning more patients to home dialysis treatments will help in keeping this vulnerable and immunocompromised population isolated from infections. Dialysis treatment centres have high risk if infection transmission due to the proximity to one another and currently there are more than three quarters if the population receiving institutional dialysis (Kidney Foundation, 2020). Transitioning institutional or “in-centre” dialysis patients to home dialysis will minimize their risk of exposure to infections and transmissible diseases such as Covid-19. In my current clinical setting, we have recently opened a new home peritoneal dialysis program and have begun to transfer appropriate hemodialysis patients to this new dialysis modality. This requires support from home care providers to assist with treatment set-up in the patient’s home.

I learned about the scare kidney care resources that are available to indigenous communities due to the rural area in which they are located. Implementing more resources such as dialysis treatment centres and making established kidney programs expand home dialysis to these areas will provide greater access to end stage renal disease treatment. Of course, these ideas I have do not consider cost and resource allocation in an already burdened healthcare system. I like to think that if there were no obstacles to serving this vulnerable population more effectively, these ideas would be the first of many to be implemented.

Erdmann, R., Morrin, L., Harvey, R., Joya, L., Clifford, A., & Soroka, S. (2020). Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease—Evidence to Inform Policy. Canadian Journal of Kidney Health and Disease, 7, 2054358120930977.

Harel, Z., Wald, R., Perl, J., Schwartz, D., & Bell, C. M. (2012). Evaluation of deficiencies in current discharge summaries for dialysis patients in Canada. Journal of multidisciplinary healthcare, 5, 77.

Schlieper, G., Hess, K., Floege, J., & Marx, N. (2016). The vulnerable patient with chronic kidney disease. Nephrology Dialysis Transplantation, 31(3), 382-390.