Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients

Abstract

Background Patients receiving in-center hemodialysis treatment face unique challenges during the COVID-19 pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined. Methods We explored the role of variables including community disease burden, dialysis unit attributes (size, layout) and infection control strategies, on rates of COVID-19 among patients receiving in center hemodialysis in London, UK, between March 2nd 2020 and May 31st 2020. The two outcomes were defined as (i) a positive test for infection or admission with suspected COVID19 and (ii) admission to the hospital with suspected infection. Associations were examined using a discrete-time multi-level time-to-event analysis. Results Data on 5,755 patients, dialysing in 51 units were analysed. 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between 2nd March and 31st May 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates and dialysis unit size. Greater number of available side rooms and introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices nor with any of the different isolation strategies. Conclusions Rates of COVID-19 in the in center-hemodialysis population relate to individual factors, underlying community transmission, unit size and layout.

Analysis of Experiences in Preventing COVID-19 in Hemodialysis Centers of the North of Poland before the Era of Vaccination

“…This study confirms previous findings that chronic HD patients are at a high risk of developing COVID-19 [ 12 , 13 , 14 , 15 ]. Moreover, we confirm that the implementation of preventive structural and organizational changes applied to all patients and healthcare personnel may decrease the risk of local transmission of SARS-CoV-2 infection [ 16 , 17 ]. We demonstrated that COVID-19 incidence varied widely by dialysis units from 9.4% to 36.4%; thus, one may hypothesize these variations may be due to the too-liberal policy adopted by some units with regard to safety measures.…”

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

“…Lastly, recent national studies on hospitalization and mortality rates among patients with ESKD in the first wave of the pandemic similarly found significant differences in adjusted relative rates with respect to patient age, sex, race, and ethnicity. 64,65 We further highlight several differences in risk factors between COVID-19 and mortality. First, higher BMI was associated with higher hazards for COVID-19 and mortality, consistent with findings in the general population.…”

“…Lastly, recent national studies on hospitalization and mortality rates among patients with ESKD in the first wave of the pandemic similarly found significant differences in adjusted relative rates with respect to patient age, sex, race, and ethnicity. 64 , 65 …”

Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

“…Larger studies have investigated disease severity using hospital admission as a proxy. 25 26 We opted to explore a different definition of severity; early in the pandemic admissions occurred to facilitate the logistics of isolated dialysis for COVID-19 patients who were otherwise well, and therefore an admission per se may not be truly reflective of disease severity.…”