Prolonged shedding of SARS‐CoV‐2 in COVID‐19 infected hemodialysis patients

Abstract

An outbreak of coronavirus disease 2019 , now known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that began in China in December 2019, has since spread rapidly throughout the world. 1 There are several reports of hemodialysis patients with COVID-19. [2][3][4] Hemodialysis patients appear to be a population at high risk for severe COVID-19, because factors identified as risk factors for severe COVID-19 are often present in these patients: old age, hypertension, cardiovascular comorbidity, and diabetes mellitus. In addition, these patients also show impaired antiviral immune responses, because of the impaired kidney function. On the other hand, hemodialysis patients may not be at a higher risk for more severe COVID-19 in other respects: They are also aware of their vulnerable condition, they know that they should seek medical advice immediately when they have fever or other complaints, and they have an immunosuppressed state which may attenuate the hyperinflammatory response observed in the stage of severe COVID-19. The usual clinical course of hemodialysis patients with COVID-19 is not yet clear. We examined 5 hemodialysis patients with COVID-19 at our hospital and report, herein, the prolonged persistence of a positive result of the PCR test for SARS-CoV2 in hemodialysis patients.

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

“…Nasal shedding of SARS-CoV-2 was detected in 41% of patients by day 15 following the initial positive swab [ 100 ]. On average shedding of viral particles lasted 15.1–29 days in infected patients on HD [ 135 , 139 ]. Two studies reported that HD patients tested positive for SARS-CoV-2 RNA on repeated testing despite being negative on two prior consecutive nasopharyngeal swabs [ 138 , 140 ].…”

“…Whereas the former two issues are of easy resolution, discontinuing transmission-based precautions for HD patients relies on more complex underpinnings. The immune-suppressed HD patients may shed the virus longer than previously recognized [ 139 ]. Given the evolving recommendations on the criteria for discontinuing isolation [ 157 , 158 ], may be prudential to consider HD patients as immuno-compromised and await the resolution of nasal shedding before de-isolating these patients.…”

“…On this issue, a large amount of literature was published by the countries mostly hard-hit by the disease, namely, US, China, Italy, Brazil and UK [156]. [131,133,134] (Median) (Mean) Time elapsed from diagnosis to death 5-31.5 [15,110,139] 8 [62] (Median) (Mean) Time elapsed from symptoms to death 7-17 [11,21,109,119,124,157] 14-16 [134] (Median) (Mean) Time elapsed from hospital admission to death 6-14 [11,109,119,124,153] 12.3 [131] (Median) (Mean)…”

Characteristics of the 6th Japanese wave of COVID-19 in hemodialysis patients

“…In addition, these patients also show impaired antiviral immune responses because of their impaired kidney functions. Hemodialysis patients with COVID-19 reportedly have a poor prognosis [5][6][7][8][9]. In the present study, we examined the clinical characteristics of hemodialysis patients with COVID-19 during the 6th wave of infection at our hospital.…”

Characteristics of hemodialysis patient with critical COVID‐19

“…In addition, these patients also have impaired antiviral immune responses because of their impaired kidney functions. Numerous reports of hemodialysis patients with COVID-19 have been published [2][3][4][5][6][7][8][9]; however, the usual clinical course of hemodialysis patients with COVID-19 remains unclear. We examined data from hemodialysis patients with COVID-19 at our hospital and report the differences between patients with critical and noncritical disease severity.…”