Persons with kidney disease and on haemodialysis advised to follow guidelines to mitigate risk of COVID-19 infections

NEW DELHI, MARCH 19. The COVID-19 pandemic is throwing up unique challenges for health systems. It presents particular challenges for patients who receive regular haemodialysis. These patients with damaged kidneys, also known as uremic patients, are particularly vulnerable to infection and may exhibit greater variations in clinical symptoms and infectivity.

“Unlike other at-risk individuals, these patients do not have the ability to stay at home and not interact with others. Despite being high risk they must travel to dialysis centers 2-3 times every week. This significantly increases the risk of transmission of infection, to patients themselves, family members, medical staff and facility workers, and all others,” says Prof Vivekanand Jha, Executive Director, George Institute for Global Health India and President of the International Society of Nephrology.

COVID-19, a pandemic caused by a novel coronavirus, is a major global human threat Kidney involvement seems to be frequent in this infection and when severe, is an independent predictor of mortality.

In a paper entitled “The Novel Coronavirus 2019 epidemic and the Kidneys”, written by an expert group of nephrologists from around the world including China, it has been pointed out that all family members living with dialysis patients must follow the precautions and regulations given to patients to prevent person-to-person and within family transmission of the COVID-19, which include body temperature measurement, good personal hygiene, handwashing, and prompt reporting of potentially sick people.

The management of patients on dialysis who have been suspected to have been in contact with COVID-19 should be carried out according to strict protocols to minimize risk to other patients and healthcare personnel taking care of these patients,” said Prof Jha. These guidelines have been made available on the International Society of Nephrology website.

In previous reports of SARS and MERS-CoV infections, acute kidney injury developed in 5 to15 per cent cases and carried a high (60 to 90 per cent) mortality. Early reports suggested a lower incidence (3 to 9 per cent) of AKI in those with COVID-19 infection. Recent reports, however, have shown higher frequency of kidney abnormalities. A study of 59 patients with COVID-19 found that about two-third of patients developed massive leak of protein in urine during their stay in hospital.

Like all other persons with potential COVID risk, supportive care, namely bed rest, nutritional and fluid support, and maintenance of blood pressure and oxygenation are important measures, as for all critically ill patients. Other measures include prevention and treatment of complications by providing organ support, maintaining hemodynamic stability, and preventing secondary infection.