Severe Acute Respiratory Syndrome in Dialysis Patients

Abstract

Abstract. Reviewed are the clinical features and outcome of 12 chronic dialysis patients (six men) who contracted severe acute respiratory syndrome (SARS) compared with 23 sex-and agematched nonuremic SARS patients as controls. Eight were on peritoneal dialysis (PD) and four on hemodialysis. Mean age was 58 Ϯ 12 yr for the dialysis patients, and 57 Ϯ 12 yr for the controls. The presenting symptoms of dialysis patients were similar to the controls. With appropriate protection measures, hemodialysis was performed in a dedicated area of the SARS isolation ward, while PD was continued as intermittent PD. In all seven patients with PD effluent tested, SARS-related coronavirus (CoV) could not be identified by polymerase chain reaction (PCR) or viral culture. Three dialysis patients had persistent positive stool PCR after 5 wk, whereas all nondialysis patients had negative stool PCR after 1 wk. Despite dosage adjustment, ribavirin-induced hemolytic anemia was more severe in the dialysis patients. Dialysis patients required longer hospitalization than the controls, but the mortality was similar. With appropriate protective measures, dialysis could be safely performed. Dialysis patients with SARS often require prolonged hospitalization. Furthermore, these patients may have an extended period of viral shedding, which should be carefully monitored for the purpose of infection control.From March to July 2003, there was a global outbreak of severe acute respiratory syndrome (SARS) (1). It affected more than 8000 people in over 30 countries (2), including China, Vietnam, Singapore, Taiwan, Germany, France, Italy, Thailand, the United Kingdom, the United States, and Canada (1,3-6). In Hong Kong, more than 1750 people contracted SARS, and nearly 300 people died (7).There are additional difficulties in the management of chronic dialysis patients who contract SARS. For example, early diagnosis is difficult, dose of antiviral medications needs to be adjusted, and there are additional infection control issues in the disposal of spent dialysate (both hemodialysis and peritoneal dialysis [PD]) and in preventing cross-contamination within the dialysis unit. To date, there have only been isolated case reports on the management of SARS in chronic dialysis patients (8 -10). Here we report the clinical features, treatment, and outcome of 12 dialysis patients with SARS from a hospital cluster in Hong Kong. Materials and MethodsWe reviewed all chronic dialysis patients from a hospital cluster in Hong Kong who were hospitalized for SARS during the epidemic period. SARS was defined according to the World Health Organization (WHO) criteria (11). The list was complied after searching through the regional database for all of the patients who were diagnosed to have or who died of SARS. One of the patients has been described in a previous report (10).We reviewed the case notes of the SARS group. The symptoms at presentation, presence of comorbidities, laboratory results, treatment regimens, need for admission to intensive care unit (ICU), lengt...

Severe Acute Respiratory Syndrome (SARS)

“…Patients on dialysis shed virus for longer periods, have greater transfusion requirements, require longer hospitalization, but have similar mortality compared with the control group. 85…”

Framework for the design and operation of high-level isolation units: consensus of the European Network of Infectious Diseases

“…This procedure avoids contamination of the drainage system with high concentrations of viruses, and protects health-care workers from the risk of spillage. The unit uses this method for peritoneal dialysate (which can contain high concentrations of virus, even if not blood-stained 63 ), and for fl uids collected when setting up haemodialysis equipment or rinsing the blood compartment at the end of the session, 64 but haemodialysis ultrafi ltrate (likely to contain no, or very low, concentrations of virus because particles of more than 7 nm diameter will be retained by the fi ltration membrane [64][65][66][67] ) is disposed of directly into the dirty drains system. Alternative decontamination methods include chemical disinfection, although the chemicals used might be ineff ective in the presence of organic matter and are potentially hazardous to healthcare workers, and heat treatment, which requires storage of wastes until treated and needs complex equipment and engineering controls.…”

Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease

“…By comparison with other patients, the care of patients undergoing renal dialysis poses several additional infection-control issues in the disposal of spent dialysate (both haemodialysis and peritoneal dialysis) and in the prevention of cross-contamination within the dialysis unit. 104 During the SARS episode, patients receiving dialysis were kept in the SARS isolation ward with the other patients with SARS. All patients with peritoneal dialysis were treated with intermittent peritoneal dialysis during their hospital stay.…”

“…The dialysis exchange was done by the ward staff , who wore full protective gear, as recommended by WHO, including waterproof disposable gowns, caps, gloves, face shields, and N95 face masks. 104 The spent peritoneal dialysis effl uent was decontaminated with a 2% sodium hypochlorite solution.…”

“…Haemodialysis was also done by the ward staff , who wore full protective gear, in a room especially equipped for SARS patients in the isolation ward. 104 Dedicated haemodialysis machines were used with an ordinary tap water supply that passed through a fi lter without reverse osmosis or any other water treatment. Spent dialysate was decontaminated as described above, and all of the blood tubing was discarded as infectious waste.…”