Often forgotten, transport modality to dialysis may be life-saving

Abstract

Haemodialysis patients commute to the dialysis facility thrice weekly, for a total of six trips per week. While nephrologists may think that how patients do this is up to them and their insurance companies, there is growing evidence that providing advice on how to commute to dialysis is part of an integrated care plan for dialysis patients. In this issue of Clinical Kidney Journal, two reports emphasize the importance of transport modality on dialysis patient well-being and even survival. Rincon et al. report on the epidemiology and clinical spectrum of coronavirus disease 2019 (COVID-19) in a Spanish haemodialysis unit. A key source of infection was related to access to healthcare or elderly care facilities. Indeed, healthcare transportation with future symptomatic [odds ratio (OR) = 3.33] or asymptomatic (OR = 4.73) COVID-19 patients increased the risk of infection. Working with transport providers to minimize cross-infection between patients during transport was one of the measures taken to stop disease transmission. Lessons learned from COVID-19 may also apply to influenza and other infections. In the second report, Yazawa et al. describe an association between transport modality to the dialysis facility and health-related quality of life (QOL) among haemodialysis patients in the Japanese Dialysis Outcomes and Practice Patterns study. These reports emphasize the need for nephrologists to understand how patients are transported to dialysis and how transport modality may be optimized to promote QOL and decrease potentially life-threatening complications.

Keywords: COVID-19; SARS-CoV-2; haemodialysis; influenza; quality of life; transportation.

FIGURE 1

Transportation means to dialysis facilities and clinical impact. The figure illustrates three different transport modalities to dialysis facilities. (A) The ambulance image represents collective healthcare transport: patients are driven by others to the dialysis facility, sometimes in shared cars. (B) The private car represents self-driving and (C) the man walking represents walking or cycling to dialysis with or without using public transport. According to the Japanese Dialysis Outcomes and Practice Patterns study data, there was a relationship between transport modality and QOL; 1 year later, QOL was lower for those who are driven to dialysis [2]. Additionally, a Spanish study showed that collective healthcare transport was associated with the risk of COVID-19 (A) [1]. This increased risk of respiratory virus infection likely extends to seasonal influenza.