COVID-19 Testing Acceptance Rates Low Among Hemodialysis Patients
Recent research has highlighted a concerning trend regarding COVID-19 testing acceptance among adults undergoing hemodialysis. A nationwide cluster trial conducted across various dialysis facilities in the United States revealed that only 8% of patients accepted testing, regardless of the strategy employed.
The study, which took place between February and July 2023, involved a total of 2,389 participants with an average age of 64 years. The demographic breakdown indicated that 56% of the participants were men, while 37% identified as Black, another 37% as White, and 14% as Hispanic. Notably, 67% of these individuals had diabetes, a condition that can complicate the management of viral infections.
Researchers implemented two distinct strategies for COVID-19 testing: a static approach that mandated testing every two weeks and a dynamic approach that adjusted testing frequency based on local infection rates. Over the course of the study, a total of 12,553 SARS-CoV-2 tests were offered to participants across 57 randomly selected hemodialysis facilities spanning 22 states.
Despite the comprehensive nature of the study, the acceptance rates remained disappointingly low, with both testing strategies yielding an identical acceptance rate of 8%. The median number of tests offered to patients was six in the static testing group and four in the dynamic group, yet this did not translate into higher participation.
Among the 503 patients who did accept at least one test, the median proportion of tests accepted was notably different between the two strategies. In the static group, patients accepted only 16% of the tests offered, while those in the dynamic group accepted a median of 50%. This suggests that while the dynamic approach did not improve overall acceptance rates, it did result in a higher proportion of tests being accepted by those who participated.
Further analysis revealed that certain demographics were more inclined to accept multiple tests. Older patients demonstrated a higher likelihood of acceptance, with an odds ratio (OR) of 1.08, indicating that for every additional year of age, the likelihood of accepting tests increased. Additionally, patients with diabetes were significantly more likely to accept testing, with an OR of 1.59, while women also showed a higher acceptance rate (OR = 1.30).
Interestingly, the study found that Hispanic patients were more willing to accept at least one test compared to their White counterparts, with an OR of 1.78. Conversely, individuals residing in areas represented by Republican Congress members were less likely to accept multiple tests compared to those living in Democratic-leaning regions, suggesting that political affiliation may influence health decisions.
Maria Montez-Rath, PhD, from Stanford University School of Medicine, emphasized the importance of surveillance screening in dialysis facilities to mitigate the adverse effects of viral illnesses. Early detection of infections can prompt healthcare providers to conduct more frequent assessments for potential complications, such as respiratory issues or hypotension, which are critical for patients undergoing maintenance dialysis.
This study underscores the challenges faced in promoting COVID-19 testing among vulnerable populations, particularly those reliant on hemodialysis. The low acceptance rates highlight the need for tailored interventions that address the specific barriers faced by these patients, ensuring they receive timely testing and care.
