Universal testing in hemodialysis facilities may ‘limit spread’ of COVID-19
A study conducted at a hemodialysis center in Paris suggests implementation of a screening procedure to test for COVID-19 may benefit patients and staff by enabling asymptomatic individuals to be identified and subsequently isolated.
“The prognosis of COVID-positive patients treated by maintenance hemodialysis is particularly poor, with a mortality rate of 21%,” Caroline Creput, MD, PhD, of the nephrology and hemodialysis unit, DIAVERUM, and colleagues wrote. “To stem this local epidemic, we adopted strict isolation measures and physical distancing measures were implemented, with some difficulties. We also conducted universal testing that allowed us to identify asymptomatic patients who could be isolated in order to limit the spread of the virus.”
For the study, Creput and colleagues included a total of 200 patients who were receiving maintenance hemodialysis at two facilities, as well as 40 staff members. All patients and staff were tested for COVID-19 via a systematic screening procedure that used a real-time reverse transcription-polymerase chain reaction (RT-PCR) assay.
In total, 38 patients were diagnosed with COVID-19, with 36 testing positive with a nasopharyngeal rt-PCR for SARS-CoV-2; four of these were asymptomatic.
“The remaining [two] patients tested negative with the rt-PCR for SARS-CoV-2 but had typical chest CT scan findings (bilateral ground-glass opacities),” researchers wrote.
Regarding staff, five tested positive for COVID-19 with rt-PCR screening; three of these individuals were asymptomatic.
Further observing that all of the those who were diagnosed with COVID-19 had lymphopenia and an increase of C-reactive protein, Creput and colleagues advised patients be monitored for these occurrences.
“Through extensive efforts, including universal RT-PCR testing of all patients and staff, cohorting patients suspected of having or with COVID-19, and addressing other key logistical issues, including waiting room crowding, we were able to mitigate the effects of COVID, with a minority of cases occurring more than [2] weeks after the initial patient was diagnosed,” Creput and colleagues wrote, adding there was “a dramatic decline [in cases] after [they] instituted aggressive mitigation efforts.”
Based on these findings, the researchers concluded these measures should be considered as “valuable” efforts to limit the spread of the virus within hemodialysis centers.
“The report by Creput [and colleagues] prompts serious consideration of whether routine universal COVID-19 screening in hemodialysis centers should be performed,” Kristine Almonte, MD, and Daniel E. Weiner, MD, MS, wrote in a related editorial.
They argued the high mortality rate for patients on dialysis favors universal testing, but cautioned RT-PCR testing could lead to false-negative or false-positive results “if staff are not well trained in obtaining specimens for testing.”
Almonte and Weiner also commented on the finding that indicated all patients had lymphopenia and a rise in CRP.
“Little has been written about serial assessment of CRP levels or lymphocyte counts, but these are potentially attractive tests that require urgent study to evaluate a potential role in COVID-19 screening,” they wrote.
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