COVID-19 At-Risk Group: Haemodialysis Patients

Wang et. al. (2020) present their case series (5 patients) on haemodialysis patients with COVID-19 from a single centre in Wuhan [1]

Summary below:

First patient in their unit was diagnosed on 9 February 2020, subsequently all renal patients attending for haemodialysis were screened

All patients presented with lymphopenia

Most common chest radiograph abnormality was ground glass opacity

Screening of patients:

1) Temperature measured prior to dialysis, temperature exceeding 37.3 Celsius or with respiratory symptoms had a chest CT

2) If CT findings were abnormal rRT-PCR testing for SARS-CoV-2 virus

Limitations: Patients with COVID-19 prior to screening and patients without an abnormal CT at the time of screening would have been missed

Infection control measures:

1) Patients were required to wear surgical masks or N95 masks throughout the hemodialysis treatment

2) No visitors were allowed

3) Dialysis centre staff members wore face shields, N95 face masks, eye shields, disposable gowns, caps, and gloves

4) Daily chlorine disinfectants used to clean items and floors

5) Circulating air UV air steriliser disinfects 4 times a day for 2 hours each time in centre


Fortunately Wang et. al. (2020) [1] reported that their series of patients had mild infections and none of them progressed to acute respiratory distress

Two patients received methylprednisolone and intravenous immunoglobulin
Two patients were given antivirals, abidol and ribavirin

Useful resources:

Kidney Care UK advice for renal and dialysis patients: resources on self-isolation, dialysis arrangements and getting support
https://www.kidneycareuk.org/news-and-campaigns/coronavirus-advice/

Nephrology Journal Club: Collection of medical education resources and protocols
http://www.nephjc.com/news/covidaki

The Internet Book of Critical Care
https://emcrit.org/ibcc/COVID19/

References:

1. Rui Wang, Cong Liao, Hong He, Chun Hu, Zimeng Wei, Zixi Hong, Chengjie Zhang, Meiyan Lia, HuaShui (In Press 31 March 2020), COVID-19 in Hemodialysis Patients: A Report of 5 Cases, American Journal of Kidney Diseases, https://doi.org/10.1053/j.ajkd.2020.03.009

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