The impact of COVID‐19 in hemodialysis patients: Experience in a hospital dialysis unit

Abstract

Introduction COVID‐19 is a very high transmission disease with a variable prognosis in the general population. Patients in hemodialysis therapy are particularly vulnerable to developing an infectious disease, but the incidence and prognosis of hemodialysis patients with COVID‐19 is still unclear. The main objective is to describe the experience of our dialysis unit in preventing and controlling the spread of SARS‐CoV‐2 infection. Methods Preventive structural and organizational changes were applied to all patients and health care personnel in order to limit the risk of local transmission of SARS‐CoV‐2 infection. Findings The Nephrology department at Sant Joan Despí Moises Broggi Hospital‐Consorci Sanitari Integral is a reference for two satellite hemodialysis centers caring for 156 patients. We combine our own hemodialysis maintenance program for 87 patients with hospitalized patients from peripheral hemodialysis centers. In this area, the reported incident rate of COVID‐19 in these peripherical hemodialysis centers was 9.5% to 19.9% and the death rate 25% to 30.5%. In our hemodialysis program, the incidence rate was 5.7%. Three out of five required hospitalization (60%) and nobody died. Discussion Although the risk of local transmission of the disease was very high due to the increase in hemodialysis patients from peripheral centers admitted to hospital, the incidence rate of COVID‐19 was very low in our own hemodialysis patients. We believe that the structural and organizational changes adopted early on and the diagnosis algorithm played an important role in minimizing the spread of the disease.

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

“…As detailed in Table 1S, different screening tests were used to estimate the prevalence of COVID-19. The screening was carried out using real-time polymerase chain reaction (RT-PCR) (45.5%) [ 11 – 21 ], serology (27.2%) [ 18 , 20 , 22 – 25 ], computed tomography (CT) scan (confirmed by SARS-CoV-2 RT-PCR) (13.6%) [ 26 – 28 ] and combination of PCR and serology (13.6%) [ 29 – 31 ]. Considering all modalities of testing, prevalence of COVID-19 among HD patients ranged between 0 and 37.6% [ 11 – 32 ].…”

“…Fistula arm was washed before starting dialysis [ 16 , 29 , 60 ]. In the COVID area, patients implemented personal protective equipment (PPE) including gloves throughout the dialysis session [ 29 , 65 – 67 ].…”

“…Public transport for suspected and/or confirmed COVID-19 patients was forbidden [ 29 , 49 – 51 , 53 , 57 , 62 , 74 ]. In the absence of separate transportation, patients with confirmed COVID-19 were gathered in the same vehicle, providing them with a mask [ 38 ].…”

“…Different routes (including lift) for symptomatic and asymptomatic patients were designed to avoid cross-contamination among subjects [ 21 , 29 , 34 , 60 , 75 ].…”

“…A separate room was reserved for testing [ 29 , 38 , 47 , 67 , 74 ] suspected or confirmed COVID-19 patients [ 16 , 21 , 29 , 33 , 36 – 38 , 40 , 43 , 46 – 48 , 50 , 52 , 56 , 57 , 62 , 68 , 77 – 79 ]. Although it was not a primary prerequisite [ 38 , 46 ], a negative air pressure room was preferable for quarantine patients [ 37 , 47 , 49 , 80 ].…”