Contingency Planning for COVID-19: Feasibility of Twice Weekly Hemodialysis in a Large Canadian Cohort
Bibliographic record
Abstract
Background: Reducing hemodialysis treatments from three times weekly to twice weekly is a potential strategy to lessen potential exposure/transmission of COVID-19 while allowing hemodialysis units to operate with fixed/reduced resources. As part of contingency planning at a large Canadian center, all facility-based hemodialysis patients were reviewed in advance for candidacy of a reduced “twice weekly” schedule. Methods: All prevalent patients receiving at least thrice weekly, facility-based hemodialysis - affiliated with the QEII Halifax, Nova Scotia, Canada - were systematically reviewed in a stepwise manner, using accepted criteria for implementing twice weekly hemodialysis (Fig. 1).Figure 1.: Stepwise approach and selection criteria to review all facility-based hemodialysis patients for candidacy of twice weekly hemodialysis (N=473).*Patients who fulfilled interdialytic fluid gain and serum potassium criteria were assessed by primary nephrologist for eligibility using each of: III. good nutritional status, IV. no clinical evidence of fluid overload, and VI. infrequent hospitalization/easily manageable co-morbid conditions (cardiovascular and pulmonary).Results: Of 473 patients assessed, only 18 (4%) fulfilled criteria for twice weekly hemodialysis (Fig 1.) Of these patients, average age was 63 ± 12 (SD) years, 61% were diabetic, 95% Caucasian; and at least 67% receiving dialysis for 6+ months prior to assessment. 83% of qualifying patients missed 0 treatments in the preceding month, and none missed >1 treatment. Average for serum albumin was 36 ± 4 g/L, Urea reduction ratio, 72.7, and residual urea clearance, 5.7 ± 2.7 mL/min/1.73m2. Conclusions: Although feasible, a twice weekly hemodialysis strategy applied to a small proportion of our patient population, potentially reflecting an ‘intention to defer’ strategy for initiating dialysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".