Delivering Dialysis During the COVID-19 Outbreak: Strategies and Outcomes

Roper, Tayeba; Kumar, Nicola; Lewis-Morris, Timothy; Moxham, Vicki; Kassimatis, Theodoros; Game, David; Breen, Cormac; Moutzouris, Dimitrios Anestis

doi:10.1016/j.ekir.2020.05.018

Cited by 19 publications

(46 citation statements)

References 5 publications

(4 reference statements)

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“…3 A kidney center that provides care to 670 hemodialysis patients in South London reported a smaller proportion of patients (11.3%) who tested positive for COVID-19 and similar rates of admission (40.8%) and death (9.2%). 16 Similar to our cohort, COVID-19 was more common in patients who attended hemodialysis using hospital-organized patient transport. 16 Determining whether features specific to our IsolHD regimen, which involved physician review at every dialysis session and liberal use of intradialytic acetaminophen and supplemental oxygen, contributed to our relatively high survival rate requires further research.…”

Section: Discussionsupporting

confidence: 75%

“…The UK Renal Registry Survey reported mortality rates of 22% for in-centre haemodialysis patients in London 3 . A kidney centre that provides care to 670 haemodialysis patients in South London reported a smaller proportion of patients (11.3%) who tested positive for COVID-19 and similar rates of admission (40.8%) and death (9.2%) 16 . Similar to our cohort, CXOVID-19 was more common in patients who attended haemodialysis using hospital-organised patient transport 16 .…”

Section: Discussionmentioning

confidence: 99%

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Cohort Study of Outpatient Hemodialysis Management Strategies for COVID-19 in North-West London

Medjeral-Thomas¹,

Thomson²,

Ashby³

et al. 2020

Kidney International Reports

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Background: Dialysis patients are at risk of severe Coronavirus Disease 2019 (COVID-19). We managed COVID-19 hemodialysis outpatients in dedicated satellite dialysis units. This provided rare opportunity to study early disease progress in community-based patients. We aimed to (i) understand COVID-19 progression, (ii) identify markers of future clinical severity, and (iii) assess associations between dialysis management strategies and COVID-19 clinical outcomes. Methods: We conducted a cohort study of all outpatients managed at a COVID-19 hemodialysis unit. We analyzed data recorded as part of providing COVID-19 clinical care. We analyzed associations between features at diagnosis and the first 3 consecutive hemodialysis sessions in patients who required future hospital admission, and those who had died at 28 days. Results: Isolated outpatient hemodialysis was provided to 106 patients over 8 weeks. No patients received antiviral medication or hydroxychloroquine. Twenty-one patients (20%) were admitted at COVID-19 diagnosis; 29 of 85 patients (34%) were admitted after initial outpatient management; 16 patients (15%) died. By multivariate analysis, nonactive transplant list status, use of institutional transport, and increased white cell count associated with future hospitalization and increased age associated with death. Oxygen saturations progressively decreased over the first 3 dialysis sessions in the cohorts that progressed to future hospital admission or death. Mean ultrafiltration volume of the first 3 hemodialysis sessions was reduced in the same cohorts. Conclusions: Outpatient hemodialysis in patients with COVID-19 is safe for patients and staff. Features at the first 3 dialysis sessions can identify individuals at risk of future hospitalization and death from COVID-19.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Cohort Study of Outpatient Hemodialysis Management Strategies for COVID-19 in North-West London

Medjeral-Thomas¹,

Thomson²,

Ashby³

et al. 2020

Kidney International Reports

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show abstract

“…To that end, we have 4 reports published in Kidney International Reports from Wuhan, China; the Lombardy region of northern Italy; London, England; and Paris, France 2 , 3 , 4 , 5 detailing their early experience with COVID-19 outbreaks affecting patients with end-stage renal disease at outpatient dialysis facilities and leading to a large number resulting in hospitalization and, often, death, similar to our experience in New York City. 6 …”

mentioning

confidence: 87%

COVID-19 and ESRD: Entering a New Era of Uncertainty

Valeri¹

2020

Kidney International Reports

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“…Data from patients on dialysis in Europe, China and the United States indicate that incidence of infection ranges in between 11 to 19.3% and estimates for mortality range between 6.5 to 52% 7 , 8 , 9 , 10 , 11 , 12 , 13 , far exceeding estimates in the general population. In the U.S., odds of death among hospitalized patients on dialysis are 40% higher than in the general population 14 .…”

Section: Introductionmentioning

confidence: 93%