Dialysis clinics maintain measures adopted in the pandemic even after vaccination

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Even with the high rate of vaccination, hemodialysis clinics decided to maintain, in their routines, protocols adopted with the arrival of Covid. The intention is to protect patients who, in addition to undergoing renal replacement therapy, may have changes in other body systems.

People who need dialysis often have comorbidities that affect the immune system, such as high blood pressure and diabetes. Treatment is indicated when there is loss of kidney function — when the kidney functions at less than 15% of its capacity.

Bruno Haddad, a specialist in health management at Harvard Business School and president of the DaVita Renal Treatment network, explains that the impacts of kidney disease are not restricted to the kidney’s filtering function.

“Patients’ health problems impact the endocrine system, blood production, the ability to maintain muscle mass, bone composition and even thermal regulation.”

These issues add to the compromise of the immune system — weakened in kidney patients due to the accumulation of toxins in the body —, increasing the possibility of viral and bacterial infections. Despite the greater risks, Américo Cuvello, coordinator of the Nephrology and Dialysis Center at the Hospital Alemão Oswaldo Cruz, clarifies that the guidelines are the same for the entire population.

“The care of immunosuppressed patients is similar to that imposed on the general population in the pandemic. They should avoid crowds, wear masks in closed places, wash their hands frequently or sanitize them with gel alcohol and avoid contact with individuals known to be sick”, says Cuvello. .

The measures adopted in the clinics continue: use of complete personal protective equipment by the employees; use of masks by patients throughout the process, which can last up to four hours; companions only in cases of extreme need and without meals during hemodialysis.

“Clinics have adapted to continue treatments by adopting these measures”, says Washington Eduardo, a hemodialysis patient for seven years and treasurer of the Association of Renal Patients in Balneário Camboriú (SC). “For positive cases of Covid, specific rooms and isolation areas were created. Other infectious diseases maintain isolation protocols”, he adds.

Before vaccination, there was a risk of interruption of treatments due to the removal of infected professionals, but this threat is less now. The average number of coronavirus infections continues to decline and reported cases are less severe. However, experts in the field continue to warn of the risks of infections in the most vulnerable individuals.

Low cellular immunity is accompanied, in chronic kidney patients, by the reduction of humoral immunity, responsible for the production of antibodies. According to nephrologist Cuvello, this situation impairs the response to vaccines, making this group more vulnerable to any infection.

Added to the current circulation of the virus, these factors make the recommendations for the prevention of contagion continue even if the vaccines have been taken by these patients.

The rise in monkeypox cases sparked another alert for the industry, but without the same concern. The transmissibility of the disease is lower compared to Covid, as it requires prolonged contact with symptomatic patients. It is expected that the hygiene imposed by the pandemic will be sufficient to avoid contagion in hemodialysis.

The president of SBN (Brazilian Society of Nephrology), Osvaldo Vieira Neto, says he has not seen much movement in nephrology. “Monkey smallpox transmits very little, given the current scenario it is [uma questão] quite secondary”.

The picture cited by the doctor involves the financial sustainability of hemodialysis in the country. The services are mostly provided by private companies in partnership with the SUS. But, according to these companies, the financial transfers are not enough to cover the operation.

Clinics claim that the new salary floor for nursing, on trial by the Federal Supreme Court (STF) until Friday (16), may exacerbate the sector’s crisis — as the salary increase will raise costs.


Seminar Covid Risks in Vulnerable Patients; watch:

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