Table 1.

Impact of COVID-19 on Various Aspects of Care of Patients on Home Dialysis and Strategies to Cope

COVID-19 Impact	Strategies to Cope
Effect on clinical protocols	•The use of Telehealth technology for nursing/monthly physician visits •The use of telemonitoring •Prescribe 90-day supply of medications if possible •Ship injectable medications for self-administration or at a local provider's office •Streamline in-person visits when needed with proper infection precautions •Defer routine lab draws, adequacy studies, PET, if not clinically indicated •Arrange for local laboratories when needed
Dialysis supply chain disruptions	•Ensure patients have dialysis supplies to last at least a month •Reuse surgical masks/use homemade masks for connections/disconnections
Alterations to dialysis prescription	•Start new patients on CAPD rather than APD •Make PD or HHD prescriptions as clinically indicated
Modifications to patient training protocols	•Train new patients on PD on CAPD instead of APD •Use telehealth to supplement and shorten time spent on in-person training
Dialysis staff management	•Develop contingency plans for potential staff shortages and share staff among other dialysis units in the area •Consider rotating staff on a schedule for remote/in-person work to allow staff to satisfy their care obligations, improve morale, and decrease exposure to infection.

PET, peritoneal equilibration test; APD, automated peritoneal dialysis; CAPD, continuous ambulatory peritoneal dialysis; PD, peritoneal dialysis; HHD, home hemodialysis.