Management of Patients on Dialysis and With Kidney Transplantation During the SARS-CoV-2 (COVID-19) Pandemic in Brescia, Italy

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease , is a major pandemic challenging health care systems around the world. The optimal management of patients infected with COVID-19 is still unclear, although the consensus is moving toward the need of a biphasic approach. During the first phase of the disease (from onset of the symptoms up to 7-10 days) viral-induced effects are prominent, with the opportunity to institute antiviral therapy. In the second inflammatory phase of the disease, immunosuppressive strategies (for example with glucocorticoids or anticytokine drugs) may be considered. This latter stage is characterized by the development of progressive lung involvement with increasing oxygen requirements and occasionally signs of the hemophagocytic syndrome. The management of the disease in patients with kidney disease is even more challenging, especially in those who are immunosuppressed or with severe comorbidities. Here we present the therapeutic approach used in Brescia (Italy) for managing patients infected with COVID-19 who underwent kidney transplantation and are receiving hemodialysis. Furthermore, we provide some clinical and physiopathological background, as well as preliminary outcome data of our cohort, to better clarify the pathogenesis of the disease and clinical management.

Management and Outcomes of patients on maintenance dialysis during the COVID-19 pandemic: a report from Geneva, Switzerland

“…Few reports have recently been published on dialysis units ongoing experience during the COVID-19 outbreak. They provide epidemiological data on infection and mortality rates within their dialysis population [14][15][16][17] .…”

Emelt szintű szervtámogató és életfenntartó kezelések kritikus állapotú COVID–19-fertőzött betegeken

“…Technikai megfontolás: a kezeléshez a leginkább femoralis helyzetű kanül javasolt, megfigyelések szerint a rendszer bealvadásának kockázata így a legkisebb [9].…”

Long‐term effects of COVID‐19 in a patient on maintenance dialysis

“…1 There is little information about the outcome of patients with chronic kidney disease. [2][3][4][5][6][7] Patients on renal replacement therapy are the most vulnerable for SARS-CoV-2 infection, as they are old and have a high burden of multiple comorbidities. We report clinical manifestation and outcome of COVID-19 in a patient on maintenance dialysis with long-term infection due to recurrent polymerase chain reaction (PCR) positivity and recrudescence of COVID-19 after clinical and laboratory resolution of the disease.…”