Introduction
Renal disease is predominantly a disease of the elderly and middle aged, however in recent years there has been increase in the young adult population with renal disease. This is multifactorial but maybe contributed to by the increase in young ones transitioning from the paediatric services affected by multiple chronic conditions including renal disease (1) who previously would not have survived. End stage renal disease is best managed by transplantation which provides individuals who are fit enough for the surgery ultimately with the best quality of life. Despite this several of our young adults require dialysis temporarily and in some instances indefinitely. Dialysis for young people can be extremely daunting hence our practice of cohorting our young adults on a single shift where feasible; a practice adopted since 2015 (2). The current COVID 19 pandemic has led to significant change to how we deliver our dialysis service leading to further impact on young adult population.
Methods
Our young adults undergo regular assessment of their wellbeing in order to detect any instability early on. Adopted questionnaires utilizing multiple choice questions offering the opportunity for graded responses were administered. This allowed for patient driven responses enabled by adopting, Interpretative Phenominological Analysis (IPA) developed in conjunction with our psychology team. The serial questionnaires threw up concerns and consistency in variation of response among the Young Adults pre and post COVID19 when the cohorts had to be disbanded to enable cohorting of COVID-19 positive patients during the pandemic. Questionnaires of the same group of patients were compared pre and post COVID19 as closely as possible
Results
We analysed 16 questionnaires from Young adults aged 18 and 27 years, established on dialysis with mental capacity to independently complete questionnaires. The consistent emerging themes in our free text comment reflecting lived experiences were longing for peer support 61.5% transport 23% and communications 15% (Figure 4) 50% very satisfied with the dialysis environment when dialysing in cohorts whilst in the non-cohorted only 25% were very satisfied (Figure 1). Non-cohorting young adults only 68.75% felt they were understood either quiet well/extremely well, 87.5% felt that they were understood either quiet well/ extremely well in comparison to whilst. Young patients preferred dialysing in the same cohorts some direct quotes “Dialysing with older people can be depressing & demotivating’’, ‘’I wouldn’t mind dialysing with people my own age as I would feel less different seeing people like me” (Figure 3). Satisfaction overall young adult services remained high but fell from 87.5 to 75% post COVID19 (Figure 2)
Conclusions
COVID-19 has significantly impacted some our most vulnerable dialysis patients our young adults.The demographics of this group were predominantly females, with the age range of 18-27 years old which may have influenced overall responses however the message was consistent within the limitations. COVID19 pandemic is significantly impacting practice and care in some of the most vulnerable of our patients which is being little reported in our reports and journals. Re-allocation of resources will need to be considered as we emerge from the pandemic as this is likely an impact that is being felt across the trust for young adults with chronic disease.
No conflict of interest