COVID‐19 and care for patients with chronic kidney disease: Challenges and lessons

Abstract

The COVID-19 pandemic has blurred the traditional distinction between communicable diseases (CD) and noncommunicable diseases (NCDs). The manifestations of COVID-19 range from an asymptomatic carrier state to fatal multiorgan failure. While initial reports did not report significant effects on the kidneys, it is now well established that kidney involvement (acute kidney injury, urinary abnormalities, tubular function defects) in COVID-19 is common and also associated with poorer outcomes. At the same time, care for patients with existing chronic kidney disease (CKD) has suffered during this pandemic and those with CKD are considered higher risk for severity of COVID-19 symptoms. Widespread lockdowns have affected the delivery of health care to patients with CKD, including those on dialysis or on transplant wait-lists. The pandemic has reinforced the need for accessible home-based therapies and highlighted the value of teleconsultation and remote monitoring technologies. COVID-19 has revealed the poor emergency preparedness by health systems around the world. It has underscored glaring inequities in availability of diagnostic tests and essential medications in different countries, including for dialysis. In response, there has been increasing recognition of the necessity of universal health coverage and in prioritizing vaccine distribution to serve the most vulnerable, including those with renal failure. The COVID-19 pandemic has also reaffirmed the role of the environment and ecosystems contributing to both CDs and NCDs. Attention to universal health coverage through a One Health approach is needed to prevent global health crises and prevent furtherkidney dysfunction and failure.

COVID‐19 effect on patients with noncommunicable diseases: A narrative review

“… 33 The COVID‐19 infection has been related to kidney dysfunction which then increases the risk of mortality. 37 The challenges that CKD patients faced during the pandemic include operating healthcare services, available healthcare workers, and access to important medications and diagnostics, especially for those who require dialysis or kidney transplant. 37 A study from India discussed the effect that the pandemic has done on dialysis patients, and it showed that approximately 30% of patients missed at least one session of dialysis and 3% required emergency dialysis.…”

“…It is the fourth most common chronic illness that causes serious COVID‐19 infection outcomes 33 . The COVID‐19 infection has been related to kidney dysfunction which then increases the risk of mortality 37 . The challenges that CKD patients faced during the pandemic include operating healthcare services, available healthcare workers, and access to important medications and diagnostics, especially for those who require dialysis or kidney transplant 37 .…”

“…37 The challenges that CKD patients faced during the pandemic include operating healthcare services, available healthcare workers, and access to important medications and diagnostics, especially for those who require dialysis or kidney transplant. 37 A study from India discussed the effect that the pandemic has done on dialysis patients, and it showed that approximately 30% of patients missed at least one session of dialysis and 3% required emergency dialysis. 38 Any autoimmune disease, including kidney diseases, may be prescribed immunosuppression medications that work by lowering the immune system activity which makes it harder to fight off infections like COVID-19.…”

From Alpha to Omicron: anatomy of the SARS-CoV-2 pandemic in an outpatient haemodialysis unit in Johannesburg, South Africa

“…The case fatality rate in patients receiving chronic dialysis in the developed world has been documented to be significantly higher than that of the general population [6], approaching 30% in some series [7]. Comorbidities such as ischaemic heart disease, diabetes mellitus, and hypertension, as well as the advanced age of the dialysis population in these series are likely contributors to the excess mortality in these reports [1].…”

“…In-centre haemodialysis is associated with an increased risk of acquiring infection with the novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) through healthcare-associated transmission of the virus [1]. Prolonged viral shedding in patients living with kidney failure (KF) may compound the risk of infection through patient-to-patient transmission [2,3].…”