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QALYs, DALYs and Now PALYs: Strengthening the Argument for Prevention of CKD.

Background: Hemodialysis patients had to face numerous challenges during the COVID-19 pandemic. They are at increased risk of severe complications of COVID-19 and continued to visit hospitals thrice weekly, increasing their risk of being infected. The objective of this study was to document the impact of the COVID-19 on patient's experience in hemodialysis in Quebec. Methods: Between November 2020 and May 2021, we conducted semi-structured interviews with 20 patients who were undergoing dialysis treatments in six hemodialysis units in Montreal. Interviews were transcribed and analyzed using thematic content analysis. Results: Patients were satisfied by the measures implemented within their units in order to prevent COVID-19 outbreaks, such as making masks mandatory, restricting access to the dialysis ward, and even limiting the number of accompanying persons allowed. Participants reported that following the public health guidelines (social distancing, wearing a mask and washing hands) was easy and important in order to ensure their own and their family members' safety. Because of this, participants were more likely to refuse to see their family resulting in feeling of isolation. This was particularly relevant for Indigenous patients who were having their hemodialysis treatment away from their home and family. This sub-group experienced particular issues due to the prolonged remoteness from their loved ones, change in their hemodialysis center and with the measures put in place by the hotel they were residing at. Even though their usual routine outside of dialysis might have changed due to the pandemic, hemodialysis treatments allowed patients to keep a certain normality in their lives. Positive consequences were mentioned such as frequent contact through telemedicine and the existing solidarity between patients during the pandemics. Conclusions: Patients undergoing hemodialysis faced particular challenges due to the COVID-19 pandemic. Nonetheless, they showed great resilience in their capacity to adapt to the new reality of their hemodialysis treatments.