Impact of the COVID-19 pandemic on Services for Patients with Chronic Kidney Disease: Findings of a National Survey of UK Kidney Centres

Lucy Mackintosh, Amanda Busby, Kenneth Farrington, Janine Hawkins, Sarah Afuwape, Paul Bristow, Maria Da Silva-Gane, Natalie Hall, Tess Harris, Joanna Hudson, Sam Norton, Paula Ormandy, Christina J. Pearce, Shalini Santhakumaran, Shivani Sharma, Sivakumar Sridharan, Retha Steenkamp, Julie Slevin, David Wellsted, Joseph Chilcot

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Abstract

Background
Services for patients with kidney disease underwent radical adaptations in response to the COVID-19 pandemic. We undertook an online national survey of UK kidney centres to understand the nature, range, and degree of variation in these changes and to explore factors contributing to differing practice.
Methods
The survey was designed by a multidisciplinary team of kidney professionals, service users and researchers. It enquired about centre services and staffing, including psychosocial provision, and changes to these in response to the COVID-19 pandemic. Links to the survey were sent to all 68 UK kidney centres and remained active from December 2021 to April 2022, and a revised version to nurses in late 2022 for additional data. Quantitative data were analysed descriptively. Content analysis on free-text responses identified common themes.
Results
Analysable responses were received from 41 out of the 68 UK centres (60%), with partial data from an additional 7 (11%). Adaptations were system-wide and affected all aspects of service provision. Some changes were almost universal such as virtual consultations for outpatient appointments, with significant variation in others. Outpatient activity varied from fully maintained to suspended. Many centres reduced peritoneal dialysis access provision but in some this was increased. Centres considered that changes to transplant surgical services and for patients with advanced CKD approaching end-stage kidney disease had the greatest impact on patients. Few centres implemented adjustments aimed at vulnerable and underrepresented groups, including the frail elderly, people with language and communication needs, and those with mental health needs. Communication issues were attributed to rapid evolution of the pandemic, changing planning guidance and lack of resources. Staffing shortages, involving all staff groups particularly nurses, mainly due to COVID-19 infection and redeployment, were compounded by deficiencies in staffing establishments and high vacancy levels. Centres cited three main lessons influencing future service delivery, the need for service redesign, improvements in communication, and better support for staff.
Conclusion
Kidney centre responses to the pandemic involved adaptations across the whole service. Though some changes were almost universal, there was wide variation in other areas. Exploring the role of centre characteristics may help planning for potential future severe service disruptions.
Original languageEnglish
Article number356
Pages (from-to)1-12
Number of pages12
JournalBMC Nephrology
Volume24
Issue number1
DOIs
Publication statusPublished - 4 Dec 2023

Keywords

  • Chronic kidney disease
  • Coronavirus
  • Kidney care
  • Service provision
  • COVID-19/epidemiology
  • Pandemics
  • Humans
  • Renal Insufficiency, Chronic/epidemiology
  • Aged
  • Kidney
  • United Kingdom/epidemiology
  • Renal Dialysis

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