Analysis profiles patients with ESKD at high risk for COVID-19, offers treatment precautions
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Pregnant women, newborns, the elderly and patients with comorbidities, like diabetes mellitus, hypertension and cardiovascular disease, have the highest risk of contracting COVID-19, researchers wrote after analyzing data from patients with kidney disease in China.
“COVID-19 infection presents particular challenges for patients on dialysis, in particular, in- center hemodialysis,” Saraladevi Naicker, MD, of the University of the Witwatersrand in Johannesburg, and colleagues from Taiwan and China, wrote. “Uremic patients are particularly vulnerable to infection and may exhibit greater variations in clinical symptoms and infectivity. In-center [hemodialysis] HD significantly increases the risk of transmission of infection, including to medical staff and facility workers, patients themselves and family members, and all others.”
The researchers also identified AKI as an independent risk factor for the virus.
“ ... Recent reports have also shown a higher frequency of renal abnormalities. A study of 59 patients with COVID-19 found that 34% of patients developed massive albuminuria on the first day of admission, and 63% developed proteinuria during their stay in hospital,” the researchers noted. “[Blood urea nitrogen] BUN was elevated in 27% overall and in two-thirds of patients who died. A CT scan of the kidneys showed reduced density, suggestive of inflammation and edema.”
Naicker and his colleagues reviewed the medical history of 37 patients on hemodialysis and four staff members who developed COVID-19 infection between Jan. 14 and Feb. 17, 2020, at a dialysis center in Wuhan, China. Seven patients died at that center, including six who contracted COVID-19.
“[Hemodialysis] HD patients with COVID-19 had less lymphopenia, lower serum levels of inflammatory cytokines and milder clinical disease than other patients with COVID-19 infection,” the researchers wrote.
At the time of publication, 88,948 cases of COVID-19 had been reported in 65 countries, with 79,842 in mainland China.
“The majority of infections are mild, presenting with a flu-like illness. The common clinical presentations of COVID-19 are fever (98%), cough (76%), and myalgia and fatigue (18% each), with accompanying leucopenia (25%) and lymphopenia (63%),” they wrote.
The authors detailed some of the guidelines offered by the Chinese Society of Nephrology and the Taiwan Society of Nephrology for dialysis units during the COVID-19 outbreak. These include the following:
- Minimize group activities, including group rounds, group studies and case discussions;
- For dialysis staff members, have meals at different times to avoid dining together. Remove goggles, masks and hats before meals; minimize talking during meals to reduce the spread of droplets. Patients should avoid meals during dialysis;
- If patients with suspected or confirmed COVID-19 infection must continue to dialyze in the clinic, dialysis shift personnel and caregiver staff should stay on the same shifts to avoid cross contamination and infection;
- All personnel involved in direct patient care should undertake full protection, including long-sleeved waterproof isolation clothing, hair caps, goggles, gloves and medical masks; and
- Family members living with patients on dialysis must follow all the precautions and regulations given to patients, including body temperature measurement, good personal hygiene, handwashing and prompt reporting of potentially sick people.
“COVID-19 ... is a major global human threat with a potential to turn into a pandemic,” the researchers wrote. “[T]he management of patients on dialysis who have been suspected to have been in contact with COVID-19 should be carried out according to strict protocols to minimize risk to other patients and health care personnel taking care of these patients.” – by Mark E. Neumann
Disclosure: Healio Nephrology could not confirm relevant financial disclosures at the time of publication.
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Naicker S, et al. Kid Intl.2020;doi:10.1016/j.kint.2020.03.001
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