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Chronic kidney disease is the seventh leading cause of death in the Philippines, 1 with the most

number of deaths due to renal failure in Southeast Asia. 2 If left untreated, people with this
disease require hemodialysis (i.e. a procedure to clean a person's blood through a machine) or a
renal transplant.1 The current COVID-19 pandemic has further exacerbated the already life-
threatening and expensive situation of hemodialysis patients as they are immunocompromised
and therefore highly vulnerable. For instance, a recent study conducted during the early phase of
the COVID-19 outbreak in the Philippines (between 1 April to 31 July 2020 at a tertiary hospital
in Manila) revealed that 25% death rate among hemodialysis patients admitted with COVID-
19.3 Hemodialysis patients manifesting COVID-19 symptoms needed to pay for the reverse
transcription-polymerase chain reaction tests, nurses’ personal protective equipment (PPE), and
hazard pay4 on top of their already costly hemodialysis session fees. Such a financial obstacle
and the lack of dialysis clinics that can accommodate COVID-infected dialysis patients have led
to missed dialysis sessions, eventually leading to death due to complications (e.g. pulmonary
complications).4

While some governmental efforts are in place to ensure the health and safety of the hemodialysis
patients during the COVID-19 pandemic (e.g. increasing coverage of annual benefit package
from 90 sessions to 144 hemodialysis sessions covered and increasing capacity of hemodialysis
clinics),4,5 their mental health has been largely neglected in terms of research and policies
especially in the time of pandemic where they are most at risk. This is not surprising as mental
health is often not perceived as a priority or urgent concern. The detrimental impact of their
declining health condition on their mental health 6 is aggravated by the financial need to support
their hemodialysis sessions. For a developing country like the Philippines, financial problems
were found to be a strong antecedent of higher depression, anxiety, stress, and lower levels of
wellbeing during the COVID-19 crisis.7,8

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