310. Single centre experience of ANCA associated vasculitis management during COVID-19 Pandemic – Success and Challenges

Background: To share the experience of delivering ANCA Associated vasculitis (AAV) treatment in a nephrology department in a district general hospital in the UK during Covid 19 pandemic.

Methods: Prior to the pandemic, the chemotherapy was being delivered by two trained nurses who are part of the home therapy team that oversees home dialysis patients and two more staff from home therapy team were trained. They coordinated the pre and post chemotherapy bloods for which the patient usually arranges an outpatient phlebotomy appointment, and the chemotherapy was delivered in a clinic room on the dialysis ward. During COVID, patients needed to be shielded away from the dialysis ward.

Results: The team managed a considerably higher number of patients with AAV during this period compared to the previous year. There were total of 7 new diagnoses in 2018/2019 compared to 15 cases in 2019/2020, which is an increase of 114%. The number of relapsed patients also increased by 3-fold as there were 2 patients in 2018/2019 versus 7 patients in 2019/2020. The arrangements were changed so that the pre and post chemotherapy bloods would be done at home and patients attend for the infusion on to a day case unit where they received the chemotherapy with full adherence to the government social distancing and personal protective equipment guidance. During this period from March 2020 to October 2021, a total of 24 patients received induction treatment with either Cyclophosphamide or Rituximab. Out of these, 5 patients were treated for other pathologies including IgA vasculitis and membranous nephropathy. A total of 14 new patients with a diagnosis of ANCA associated vasculitis started on treatment and 12 patients received IV Cyclophosphamide and 2 patients received IV Rituximab. There were 5 patients with relapse of ANCA associated vasculitis and they were all treated with IV Rituximab. On average each patient receiving IV cyclophosphamide induction therapy requires 19 home visits for phlebotomy during the course of delivering 10 doses. The team also continued their visits for regular blood tests whilst they started on maintenance Azathioprine for first few months; weekly for first months and then two weekly thereafter. For Rituximab, patients require a total of 3 visits for blood tests during the two week induction therapy.

Conclusions: The experience has been very positively accepted by both patients and the nephrology team as it reduced the number of visits the patients attended hospital as well as avoiding the delays caused by patients not being able to attend for their blood tests on time patient felt safer at home and reduced anxiety. It also was felt that it is overall less time consuming for the chemotherapy delivering nurses as they are in full control of when the bloods are taken hence chasing the results appropriately. It also relieved the pressure on phlebotomy team who were operating at much reduced capacity due to limited staffing and to allow for social distancing restrictions. The main challenges of this arrangements were that the Immunosuppression delivery team had to frequently visit the patients at their homes, which may have exposed them to more risk than if the patients attended outpatient phlebotomy. It also adds travel time to the nursing staff’s schedule that could have been utilised to achieve another task.  This arrangement may also be challenging for centres with large patient numbers.  This highlights how the existing community team could be utilised to deliver a safe service during the height of a global pandemic. In summary:  1-Safer immunosuppression delivery during pandemic with upskilling existing staff in a relatively smaller hospital. 2-Reducing hospital visits by average 19 episodes per patient per induction therapy cycle for patients on Cyclophosphamide. 3-Scope for integrating community tea in managing extremely vulnerable group of patients. 4-Scope for outpatient management for relatively stable patients diagnosed with ANCA associated vasculitis or other renal pathologies requiring immunosuppression therapy.

Disclosures – None