Aggressive Quarantine Measures Reduce the High Morbidity of COVID-19 in Patients on Maintenance Hemodialysis and Medical Staff of Hemodialysis Facilities in Wuhan, China

Abstract

Introduction: Maintenance hemodialysis (MHD) patients are highly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Medical staff of dialysis facilities without sufficient biosecurity protection are susceptible once exposed to asymptomatic coronavirus disease 2019 (COVID-19) patients. This study evaluated the epidemiological characteristics of COVID-19 in all MHD patients and medical staff of dialysis facilities in Wuhan, China. Methods: We collected COVID-19 morbidity and mortality data from MHD patients and medical staff from 52 hemodialysis centers in Wuhan. Then, we analyzed the symptoms and signs of patients and staff in our hospital (Tongji Hospital in Wuhan), and chest CT, SARS-CoV-2 nucleic acid detection and laboratory tests were performed. After aggressive quarantine of the COVID-19 patients, we followed up on the prognosis of them. Results: We analyzed the hemodialysis data from Wuhan and found that 10% of MHD patients and 6.0% of medical staff were suspected of COVID-19. Further detection of SARS-CoV-2 nucleic acid showed that 1.7% of MHD patients and 2.9% of medical staff were confirmed as having COVID-19. In our facility, 18.9% (46/244) of patients and 9.5% (6/63) of medical staff were suspected of COVID-19. Among them, 2.9% (7/244) of MHD patients and 4.8% (3/63) of medical staff tested positive for SARS-CoV-2 were confirmed as having COVID-19. Interestingly, 87.0% of MHD patients suspected of COVID-19 did not have obvious symptoms, but the CT screening showed features of viral pneumonia. There were no significant differences in symptoms, CT findings, comorbidity and laboratory findings of SARS-CoV-2 nucleic-acid-positive and -negative patients. We followed up these patients and found that 57 patients with COVID-19 died (COVID-19 mortality 8.9%). Two patients from our dialysis center with COVID-19 (mortality 4.3%) died. No new infections occurred in our dialysis center after aggressive quarantine was initiated. Conclusions: The SARS-CoV-2 infection rates in MHD patients and medical staff in dialysis facilities were both high in Wuhan. Frequent chest CT and SARS-CoV-2 nucleic acid detection were needed to screen COVID-19 patients in dialysis facilities. Through the lessons of this experience on the aggressive diagnosis and quarantine measures of COVID-19 patients, we hope medical staff avoid more infections in serious epidemic areas.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…Age was expressed in mean ± SD or median (IQR). The study of Li J et al [13]. reported 2 independent cohorts that were analyzed separately for meta-analysis.…”

“…In studies with good quality, the incidence was estimated at 5.2% (95% CI: 1.2-11.8%) of HD patients infected by COVID-19, but it was lower than in those studies with poor quality (8.7%, 95% CI: 6.4-11.2%). [13]. reported two independent cohorts that were analyzed separately for meta-analysis.…”

“…However, the implementation of isolation of patients in dedicated areas had small influence in the incidence (Figure 5a) or mortality (Figure 5b) of HD patients. [13]. reported two independent cohorts that were analyzed separately for meta-analysis.…”

“…Other prognostic factors have included dialysis vintage, thrombocytopenia, lymphopenia, and increased LDH or CRP level [23,28,36]. However, most studies have reported less severe clinical symptoms in HD patients compared with the general population [13,19,20,36]. In a Chinese series, the most common symptoms were fever, cough, and bilateral ground-glass or patchy opacity of the lungs [21].…”

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…Other prognostic factors have included dialysis vintage, thrombocytopenia, lymphopenia and increased LDH or CRP level [14,22,24]. However, most studies have reported less severe clinical symptoms in HD patients compared with the general population [22,26,27,28]. In a Chinese series, the most common symptoms were fever, cough and bilateral ground-glass or patchy opacity of the lungs [16].…”