COVID-19 AMONG DIALYSIS PATIENTS

Ptns with ESRD on DX, the prevalence of COVID-19 seems to be varied by geographic zones, from <1 % in certain zones in France to 36 % in urban zones o

Prevalence of COVID-19 among dialysis (DX) patients (Oct 2020)

 

Abbreviations:

o   MR:  mortality rates.

o   CDC: The Centers for Disease Control,

o   ASN: American Society of Nephrology,

o   ISN: International Society of Nephrology.

 

Ptns with ESRD on DX, the prevalence of COVID-19 seems to be varied by geographic zones, from <1 % in certain zones in France to 36 % in urban zones of the UK. In a US- cross-sectional study of > 28,000 ptns from about 1300 DX centres, the prevalence of COVID-19, examined for SARS-CoV-2 AB, was 8 %. An elevated odd of sero+ve SARS-CoV-2 in residents of Black & Hispanic, very poor, and highly dense populations. These findings highlight that the reported prevalence of COVID-19 among DX ptns is higher but largely reflecting the general populations within a given zone.

 

Patients receiving in-centre HDX

 

Ptns on in-centre HDX typically presented to an out-ptn facility 3 times/wk to be maintained DX that results in limitation of the ability of observing physical isolation necessary for infection control, that is contributing to a higher risk of infection in this cohort. One study from France conducted ptns maintained on in-centre DX had almost two-fold higher risk of infectious episodes as compared to those maintained on home DX. The reported prevalence of COVID-19 in DX ptns is higher but largely representing the general cohorts within certain zones. This is illustrated in the following studies:

o   US study: 👉 28,000 randomly selected ptns from about 1300 DX centres, 8-9 % of the blood samples > +ve for SARS-CoV-2 AB. There was increasing likelihood of SARS-CoV-2 AB positivity within residents of neighbourhoods with Black & Hispanic ethnicities (2-3 times higher), lower-income (2 times higher), & dense cohorts (10 times higher).

o   French study: 👉data collected from 1245 DX centre, about 3 % of ptns were COVID-19 +ve. Prevalence varied between <1-10 % according to the regions.

o   2 studies: 👉from widespread infection in the UK, 20-22 % of ptns maintained on HDX were +ve for SARS-CoV-2. One of these reports shows 36 % of ptns were +ve for SARS-CoV-2 AB, suggesting a previous infection.

 

MR among DX ptns with COVID-19 was about 20 % in 2 large reports. The CDC, ASN, & ISN have issued preliminary guidelines to guide nephrologists providing life-maintained DX care. These resources are currently and continuously updated. Minimally, all DX centres are supposed to strictly follow these recommendations. Certain DX organizations may currently follow more measures protecting the health carer staff & their ptns, according to their protective tools and other facilities.

 

References

o    Couchoud C, Bayer F, Ayav C, et al. Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients. Kidney Int 2020; 98:1519.

o    Anand S, Montez-Rath M, Han J, et al. Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study. Lancet 2020.

o    Clarke C, Prendecki M, Dhutia A, et al. High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening. J Am Soc Nephrol 2020; 31:1969.

o    Corbett RW, Blakey S, Nitsch D, et al. Epidemiology of COVID-19 in an Urban Dialysis Center. J Am Soc Nephrol 2020; 31:1815.

o    Jager KJ, Kramer A, Chesnaye NC, et al. Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney Int 2020; 98:1540.

o    Kliger AS, Silberzweig J. Mitigating Risk of COVID-19 in Dialysis Facilities. Clin J Am Soc Nephrol 2020; 15:707.

o    Centers for Disease Control and Prevention. Interim Additional Guidance for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis.html (Accessed on April 08, 2020).