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As COVID-19 continues to sweep through the nation, researchers are realizing what groups of people are especially affected by it and are more susceptible to it, such as dialysis patients.
Maya N. Clark-Cutaia, PhD, ACNP-BC, RN, Assistant Professor of Nursing and Medicine at the NYU Meyers College of Nursing, spoke to us about the patients she works with in her research studies to shine a light on exactly what is happening to certain marginalized populations.
The dialysis patients whom you care for/track, are they at high risk for getting COVID-19? Please explain.
The majority of the patients I work with on my research studies are African American, aged 50-60 years, disabled, living off of federal subsidies, with low health literacy and educational attainment. They tend to live in crowded, multi-generational homes, in neighborhoods that are under-resourced. This population of patients is at increased risk for COVID-19 because of the disproportionate incidence of the underlying conditions most associated with COVID-19: heart disease, diabetes, kidney disease, and lung conditions, such as asthma.
According to Medicare COVID-19 data, hypertension and diabetes are the first and fifth most common comorbid conditions for COVID-19 and the top causes for chronic kidney disease (CKD). CKD is the third most common comorbid condition, among Medicare recipients, with COVID-19.
They are also at increased risk because of their way of life. My patients or their family members are essential workers. They are the bus drivers, security guards, grocery clerks, and sanitation workers that keep our cities running. They often have to go to work to be paid and thus are at great risk for exposure. Living conditions are ripe for spread of disease and little, if any, was invested in these communities in regards to prevention, testing, and contact tracing.
What are the greatest needs of people with kidney disease who require dialysis?
TRANSPLANTS! While it remains true that the majority of transplants are cadaveric, 40% of transplants result from living donors. Similarly, conversations with your patients about palliative care and transplantation are vital. Ask your patients about what they know about transplants. Are they on the transplant list (why or why not)? How long do they expect to live on dialysis? Do they have a living will and advanced directives? The fact of the matter is that these patients are critically ill and their multimorbidity makes them highly complex. They need to understand their prognosis and have a say in how they live and how they die.
What are their socioeconomic challenges? What about getting the right foods to eat? Transportation to dialysis, etc.? Please explain.
Many of our patients are supported by federal subsidies. Due to the complexity of their disease and treatment regimens, many are unemployed. Treatments last 3-4 hours, three times a week, and that does not include transportation time, and getting on and off of the dialysis machine.
Patients often describe choosing between purchasing meals, paying for prescriptions, and transportation to and from dialysis sessions.
Basic necessities are often hard to come by, and the current federal programs, while they provide support, it does not mean that the support is ideal. For example, gas stations and convenience stores accept SNAP, and while this translates into food accessibility, they are not healthful food options. True groceries are limited in the neighborhoods my patients live in or require transportation to and from.
Patients often do not feel well enough on their days “off” or non-dialysis days to meal prep and typically do not have the resources to do so. The inability to maintain dietary and fluid restrictions result in patients often not feeling well, having unpleasant dialysis sessions, and can lead patients to skip sessions on account that they do not feel well enough to complete them, or dread the symptoms they will experience as a result of their need for increased filtration related to “non-adherence.” It becomes a viscous cycle that often results in hospitalization.
What can nurses do to help make sure that these patients have what they require—both to stay healthy while keeping their risk for COVID-19 down.
We all need to recognize that wearing masks and other COVID-19 precautions are not about us as individuals, but as a community. We are protecting our seniors, the immunocompromised, and those with underlying conditions, like my dialysis patients.
Educate yourselves, your friends, your family, your neighbors. If you have not been directly impacted by COVID, you will be. Stay informed about the risks to the general patient population and advocate for them. I am reminded of a news bit of a part of our administration touring a dialysis center without a mask or other personal protective equipment. It was unacceptable then, and it is unacceptable now.
No one spends as much time with patients as we do. No one is going into COVID and ICU rooms more than we do. And while I hate to make any of this political…it is. We need to not only advocate for our patients in the hospital, we also need to advocate for them in society. Advocacy groups are not for everyone, but every single vote counts, and we need to make informed decisions as medical professionals about the type of care we want to deliver to our patients and who is going to advocate for them. Vote. Vote often. Vote informed.
How else can nurses support these patients? Is there anything that they should not do?
Most nurses are well informed regarding standard precautions and contact precautions. Dialysis nurses in particular, have been donning and doffing PPE long before COVID. Those of us who do not know this patient population well need to ensure that we take the time to look up hospital policies and abide by them.
Anything else about COVID-19 and dialysis patients?
It is not over. In fact, it is far from over. COVID-19 is surging in states all over the country and as states continue to open, we need to remain vigilant and adhere to COVID precautions. Wear your masks, wash your hands, and limit exposures. Protect yourselves and protect those not capable of protecting themselves. Remain up-to-date with your local statistics and protocols. It will inform the care you provide.
I would also like each of you to know just how proud I am to call you colleagues. We have been redeployed to areas foreign to us. We have worked with limited PPE and limited information. We have traveled across country to work because we felt compelled to do so. We have left our families and cried in our coffee. We have hurt and felt a sense of guilt because we cannot contribute the way we would like to, but the constant is that we show up. We show up, and we have shown up big. Our profession is powerful and invaluable, and my chest swells with pride each passing day.