OBJECTIVES: COVID-19 impacted the provision of routine healthcare services, including life-extending measures such as haemodialysis provision among people with chronic kidney disease (CKD). We aimed to assess changes in haemodialysis provision before and after the emergence of COVID-19. We considered whether COVID-19 impacted haemodialysis access procedures specifically surgical creation of an arteriovenous fistula, as is best practice for delivery of haemodialysis, or insertion of a temporary or tunnelled dialysis access catheter.

METHODS: Using an England-wide reimbursement secondary care dataset, the Hospital Episodes Statistics, we identified all patients with CKD stage 5 or kidney failure, and a record of haemodialysis. We excluded patients who received a kidney transplant. We then used a binary classification of before (01/01/2018 – 31/12/2021) and after (01/01/2020 – 31/12/2021) the emergence of COVID-19 to classify when patients commenced dialysis. We compared number of patients whose treatment was initiated via a fistula or a dialysis access catheter using ꭕ² testing.

RESULTS: We found a 40% reduction in the number of patients with CKD5 or kidney failure receiving haemodialysis after the emergence of COVID-19 compared with before (8,595 vs 14,406, respectively). We observed a corresponding 42% decrease in the number of recorded dialysis sessions before and after COVID-19. However, there was no statistical difference in the proportion of new patients receiving their initial dialysis by dialysis access catheter compared with fistula, 2.5% of new patients with a record of access procedure had initial dialysis via a dialysis access catheter before the COVID-19 pandemic, compared with 1.8% after (p=0.42).

CONCLUSIONS: The number of dialysis access procedures did not fall following COVID-19 onset. However, the number of patients receiving dialysis was proportionally reduced. Further investigation is necessary to determine the reason, such as excess deaths of those with kidney failure or changes in patient risk attitudes to in facility treatments.