Spread of Covid‐19 in hemodialysis centres; the effects of ventilation and communal transport

Goodlad, Cate; Collier, Sophie; Davenport, Andrew

doi:10.1111/aor.14361

Cited by 3 publications

(4 citation statements)

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“…Hemodialysis (HD) patients are potentially at increased risk of contracting COVID-19, due to attending dialysis centers for treatment and spending time in the proximity to other patients and members of the dialysis nursing staff, in buildings which have poor quality ventilation, and sharing communal waiting areas and transport to and from dialysis centers. 1,2 Initial reports also suggested a higher mortality for HD patients, 1 but this may have been exacerbated by the higher underlying comorbidity and frailty of the HD population and the acute severe demand on health care resources. 3,4 On the other hand, peritoneal dialysis (PD) being a home-based therapy does not potentially expose patients to greater risks of contracting COVID-19 compared to the haemodialysis population, and several studies have reported both a lower incidence of COVID-19 infections in PD patients and lower mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Hemodialysis (HD) patients are potentially at increased risk of contracting COVID‐19, due to attending dialysis centers for treatment and spending time in the proximity to other patients and members of the dialysis nursing staff, in buildings which have poor quality ventilation, and sharing communal waiting areas and transport to and from dialysis centers 1,2 . Initial reports also suggested a higher mortality for HD patients, 1 but this may have been exacerbated by the higher underlying comorbidity and frailty of the HD population and the acute severe demand on health care resources 3,4 …”

Section: Introductionmentioning

confidence: 99%

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The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

Goodlad

Davenport

2023

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Introduction Following the first wave of COVID‐19 there have been several variants. We wished to review the number and severity of infections with the different variants in a population of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods We reviewed the outcomes and results in HD and PD patients testing positive for COVID‐19 between March 2020 and August 2022. Results Seven hundred and ninety‐five cases of COVID‐19 were recorded in 710 dialysis patients. More HD patients than PD contracted wild type (21.4% vs. 6.8%), delta (23.3% vs 6.3%), and omicron (27.7% vs. 14.7%), all p < 0.01, but no difference with alpha (4.6% vs. 6.3%) or beta variants (5.7% vs. 6.85%). Hospitalization and death were greatest for alpha followed by wild type, beta, delta, and omicron (60.6% vs. 57% vs. 47.5% vs. 21.2% vs. 19.3%), respectively, p < 0.001. C reactive protein progressively increased from outpatient management to hospitalization to hospitalization with critical care or death (14 (4–30) vs. 41 (18–101) vs. 94 (47–168) mg/L, p < 0.001. Despite previous infection and vaccination 85 (12%) patients had two or more infections with COVID‐19. Conclusion Disease severity declined and survival improved as the virus mutated from wild‐type and alpha to beta, delta, and omicron variants. Whether this related to reduction in viral virulence, vaccination, natural acquired immunity, or introduction of pharmacological treatments remains to be determined. Government lockdowns and enhanced infection control measures reduced the percentage of HD patients contracting alpha and beta variants to that of PD. Vaccination and prior infection did not prevent reinfection.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

Goodlad

Davenport

2023

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“…Sessional weight loss was less and hemoglobin higher. The first pandemic wave of COVID‐19 came in early March 2020, 25 and as such some of the weight loss, reduced nPNA and serum creatinine observed in May 2020 may have additionally been due to COVID‐19 infections, government lockdowns and restrictions on leaving the house and social activities, then followed by some improvement as COVID‐19 infections decreased. This potential effect of COVID‐19 would be supported by no apparent reduction in estimates of lean body mass 19 after 2 months of using the lower bicarbonate dialysate.…”

Section: Discussionmentioning

confidence: 99%

The effect of changing dialysate bicarbonate concentration on serum bicarbonate, body weight and normalized nitrogen appearance rate

Law

Davenport

2022

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Introduction:Most hemodialysis machines deliver a fixed bicarbonate concentration. Higher concentrations may improve acidosis, but risk post-hemodialysis alkalosis, whereas lower concentrations potentially increase acidosis but reduce alkalosis. We reviewed the effects of lowering dialysate bicarbonate. Methods:We reviewed peri-dialysis chemistries in patients switching to a lower bicarbonate dialysate at 4 time points over 19 months. Results:We studied 126 patients, mean age 63.7 ± 16.3 years, 57.9% males.Post-hemodialysis alkalosis fell from 1.6 to 0.3% sessions, but pre-hemodialysis acidosis increased from 11.9 to 23.8% sessions (p = 0.005) reducing dialysate bicarbonate from 32 to 28 mmol/L. After 3 months, pre-hemodialysis serum bicarbonate fell (21.1 ± 2.3 to 19.8 ± 2.2 mmol/L), and post-hemodialysis (24.9 ± 2.1 to 22.5 ± 2.0 mmol/L, p < 0.001) with a fall in pre-hemodialysis weight from 74.6 ± 20.7 to 71.7 ± 18.2 kg, normalized protein nitrogen accumulation rate 0.8 ± 0.28 to 0.77 ± 0.2 g/kg/day, p < 0.05, and serum albumin 39.7 ± 4.2 to 37.7 ± 4.9 g/L, p < 0.001. Thereafter, apart from pre-and post-hemodialysis serum bicarbonate, weight and normalized protein nitrogen accumulation stabilized, although albumin remained lower (37.6 ± 4.0 g/L, p < 0.001). On multivariate logistic analysis, serum bicarbonate increased more with lower pre-hemodialysis bicarbonate standardized coefficient β 0.5 (95% confidence interval −0.6 to −0.42), increased normalized protein nitrogen accumulation β 0.2 (0.96 to 2.38), p < 0.001, and session time β 0.09, (0.47 to 5.98), p < 0.022, and less with lower dialysate bicarbonate 0.0-0.23 (−1.54 to −0.74), p < 0.001. Conclusion:Increases in SE-Bic with hemodialysis, depend on the bicarbonate gradient, session time and nPNA. Lower D-Bic reduces post-hemodialysis alkalosis but increases pre-hemodialysis acidosis and may initially have adverse effects on weight and normalized protein nitrogen accumulation.

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“…There are variable reports in regard to the impact of shared transport to and from in-centre dialysis as a vector of COVID-19 infection spread. Some studies noted a significant association whilst other studies have not, though it has been recommended that patients should use private transport to and from in-centre dialysis if possible [ 15 , 77 ]. It is acknowledged that this may be challenging for many elderly haemodialysis patients who are unable to drive to and from in-centre dialysis due to their functional limitations, and many may not have family support to transport them to and from care facilities for dialysis [ 78 ].…”

Section: Prevention Strategies For Covid-19 In Elderly Haemodialysis ...mentioning

confidence: 99%

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

McDonnell

Kalra

et al. 2023

Biomedicines

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There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.

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Spread of Covid‐19 in hemodialysis centres; the effects of ventilation and communal transport

Cited by 3 publications

References 16 publications

The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

The effect of changing dialysate bicarbonate concentration on serum bicarbonate, body weight and normalized nitrogen appearance rate

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

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