Impact of the COVID-19 pandemic on the nephrology activity of hemodialysis started in an emergency context: a view from Morocco

Excerpt

During the months of confinement following the sudden and general onset of the COVID-19 pandemic, hospital activities on a world scale were oriented almost exclusively to the care of COVID-19 patients, with a very marked reduction of non-COVID-19 activities. The data published today on the impact of the pandemic on nephrology activities mainly concern kidney transplantation, as we lack data on acute hemodialysis, a major part of nephrology activities in many countries [1, 2]. In Morocco, a developing country located in the extreme northwest of Africa, with an estimated population of 37 million, the prevalence and incidence of end stage kidney disease (ESKD) are relatively high and consequently, the activity of emergency initiation of hemodialysis for patients presenting unknown or known ESKD is a major nephrology activity [3, 4]. The number of patients with ESKD on hemodialysis is also significant in our country and is estimated at more than 32,000. In Morocco, general confinement began on March 16th and ended on June 10th. This was followed by a period of gradual return to hospital activities during June and July, and since early August, we have been seeing a true second wave, with an average of 2500–4000 new cases per day. As of today, November 1st, 2020, there are 219,084 registered cases, of which more than 90% have been recorded since August 1st, 2020 [5]. The total number of cases in the eastern region, in the northeast of Morocco with approximately two million inhabitants, is 12,270. Currently, it is the sixth most affected among the 12 regions of the country, whereas it was the least affected region at the start of the pandemic. The Unit of Nephrology-Dialysis-Kidney Transplantation of the Mohammed VI University Center of Oujda began its hemodialysis activities in April 2016 and is the only university nephrology center of the eastern region to perform emergency dialysis for all patients of the region, with permanent on-call medical service 7 days a week, 24 h a day. These emergency hemodialysis sessions mainly concern patients with severe ESKD, often unknown and not yet under dialysis, and less frequently ESKD under dialysis, or severe acute kidney failure. The major indications of these sessions remain acute pulmonary edema and/or severe electrolyte disorders (hyperkalemia, hyponatremia, and acidosis), and/or uremic syndrome (digestive or neurological). Dialysis activity was considerably reduced during the periods of confinement and immediately post-confinement, with the resumption of full activity starting in late June 2020. What really happened during that period? …