Background: Recipients of outpatient haemodialysis are at an increased risk of acquiring severe SARS-CoV-2 infection. Isolation of infected patients reduces in-centre transmission, but protocols extrapolated from the general population may not be applicable in this setting. We describe the kinetics of an outbreak in a tertiary dialysis centre in Johannesburg, South Africa, to suggest an appropriate isolation strategy. Methods: Retrospective analysis of a clinical database employed to facilitate isolation of exposed and infected patients was undertaken. Modes of transmission, incubation and recovery periods in patients developing SARS-CoV-2 infection were assessed. The effects of factors modulating immune function on incubation and recovery periods were modelled using sigma-restricted partial least squares linear regression. Severity of infection and the outcomes thereof were described to assess the efficacy of the isolation protocols employed. Results: SARS-CoV-2 infection was diagnosed in 24.7% of patients receiving outpatient haemodialysis. Contact with an infected healthcare worker was the leading indication for surveillance swabbing in this cohort (49.12%). Forty per cent of all positive cases had antecedent contact with an infected healthcare worker, and possible patient-to-patient transmission occurred in one case. The median time to the diagnosis of infection following known exposure was 16.5 days. Comorbid diabetes and increasing dialysis vintage were associated with a shorter incubation period. The median time to clearance of infection was 33.5 days. The clinical disease severity prolonged the recovery period. No patient required mechanical ventilation, and there were no deaths during the study period. Conclusion: Haemodialysis patients manifest prolonged incubation and recovery periods. Serial monitoring with RT-PCR swabs may be required to ensure effective isolation.

Background Living kidney donation has been advocated as a means to ameliorate the chronic shortage of organs for transplantation. Significant rates of comorbidity and familial risk for kidney disease may limit this approach in the local context; there is currently limited data describing living donation in Africa. Methods We assessed reasons for non-donation and outcomes following donation in a cohort of 1208 ethnically diverse potential living donors evaluated over a 32-year period at a single transplant centre in South Africa. Results Medical contraindications were the commonest reason for donor exclusion. Black donors were more frequently excluded (52.1% vs. 39.3%; p<0.001), particularly for medical contraindications (44% vs. 35%; p<0.001); 298 donors proceeded to donor nephrectomy (24.7%). Although no donor required kidney replacement therapy, an estimated glomerular filtration rate below 60 ml/min/1.73 m2 was recorded in 27% of donors at a median follow-up of 3.7 years, new onset albuminuria >300 mg/day was observed in 4%, and 12.8% developed new-onset hypertension. Black ethnicity was not associated with an increased risk of adverse post-donation outcomes. Conclusion This study highlights the difficulties of pursuing live donation in a population with significant medical comorbidity, but provides reassurance of the safety of the procedure in carefully selected donors in the developing world.