COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry

Abstract

Background Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. Methods Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. Results During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. Conclusion The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.

Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

“…This is the first national study of hemodialysis patients with COVID-19 in Lebanon. Our results confirm the high mortality rate of this vulnerable population, as described in several previous reports from other countries [ 14 , 17 , 19 , 20 , 22 , 23 , 26 ]. Our patients’ death rate was estimated at 23.8%, very close to the 25% reported by the ERACODA study of 26 European and North Mediterranean countries including 768 dialysis patients [ 24 ].…”

Initial Effects of COVID-19 on Patients with ESKD

“…Patients with a kidney transplant, who are less likely to carry noted risk factors, require treatment with immunosuppressants, placing them at higher risk of severe COVID-19. 6 Registry reports in Europe have indicated that the fatality rate of COVID-19 among patients with ESKD is between 20% and 30%, [7][8][9][10] a range corroborated by single-center studies in the United States. 11,12 However, the initial effect of COVID-19 on population-level outcomes in the United States has not yet been assessed.…”

Genetic epidemiology of SARS-CoV-2 transmission in renal dialysis units – A high risk community-hospital interface

“…Data from the Scottish Renal Registry suggest that measures introduced in early April to reduce this exposure, including the use of masks to and from dialysis and individual transport, were effective; with the number of cases in people receiving dialysis falling sharply two to three weeks before the rest of the general population within Scotland. 25 In order to capitalise on the utility of such knowledge in hospital-outbreak management, the results from the sequencing data need to be generated in a timely manner. 15 , 17 However, the feasibility of implementing this rapid sequencing response in the National Health Service to date has been impeded by lack of expertise and equipment for both high-throughput whole-genome sequencing and for processing the data generated into a form interpretable by infection control and public health.…”