Critical Coronavirus Disease 2019 in a Hemodialysis Patient: A Proposed Clinical Management Strategy

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused a catastrophic global health crisis. There is a lack of mitigation and clinical management strategies for COVID-19 in specific patient cohorts such as hemodialysis (HD) patients. We report our experience in treating the first case of COVID-19 in a HD patient in Singapore who had a severe clinical course including acute respiratory distress syndrome and propose a clinical management strategy. We propose a clinical workflow in managing such patients based on available evidence from literature review. We also highlight the importance of early recognition and intervention for disease control, dialysis support in an acute hospital isolation facility, deisolation protocol, and discharge planning due to prolonged viral shedding. The case highlights important points specific to a HD patient with a COVID-19 diagnosis, tailored interventions for each stage of the disease, and deisolation considerations in the recovery phase.

Determination of problems experienced during the COVID‐19 pandemic by individuals receiving hemodialysis treatment

“…Individuals receiving hemodialysis treatment are very vulnerable in terms of COVID‐19 infection due to immunosuppression in addition to several comorbidities 6,7 . Due to hemodialysis treatment being given in common areas and inability to preserve physical distance, a tendency toward infection is created and risks increase.…”

Evaluation of Dialysis Adequacy, Interdialytic Weight Gain and Quality of Life of Hemodialysis Patients within Coronavirus Disease 2019 Pandemic

“…The previous studies on the effects of COVID-19 in hemodialysis patients have focused more on the characteristics of hemodialysis patients suffering from COVID-19 [3], [6], [7], [8], impact of drug trials on hemodialysis patients suffering from COVID-19 [9], and case report of hemodialysis patients with COVID-19 [10], [11]. No study examined hemodialysis adequacy, IDWG, and the quality of life of hemodialysis patients during the pandemic.…”

Characteristics of patients undergoing hemodialysis during Covid-19 pandemic

“…The previous studies focused more on the characteristics of hemodialysis patients with COVID-19, 6 , 7 , 8 , 9 impacts of drug trials on sufferers comorbid with COVID-19, 10 and related case reports, 11 , 12 or other qualitative studies. 13 , 14 However, there is minimal information on the characteristics of patients scheduled for hemodialysis in Indonesia during the Covid-19 pandemic in the aspect of possible limitations and induced challenges.…”