Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China
Authors: Xiong Fei , Tang Hui , Liu Li , Tu Can , Tian Jian-Bo , Lei Chun-Tao , Liu Jing , Dong Jun-Wu , Chen Wen-Li , Wang Xiao-Hui , Luo Dan , Shi Ming , Miao Xiao-Ping , Zhang Chun 
Published: May 2020

Significance Statement
Although reports indicate that patients receiving maintenance hemodialysis are at risk for severe illness with coronavirus disease 2019 (COVID-19), information about this population of patients is limited. Using data retrospectively collected from a registration system that included 7154 patients undergoing hemodialysis at 65 hospitals in Wuhan, China, the authors found that 154 patients had laboratory-confirmed COVID-19. In a detailed analysis of epidemiologic and clinical characteristics for 131 COVID-19 patients who provided oral consent, they showed that hemodialysis centers are high-risk settings for COVID-19, and described interventions that effectively prevented COVID-19 spread among patients at such centers. These measures included requiring patients to wear a medical mask during dialysis and in public, conducting universal screening for the infection, and isolating infected patients and directing them to designated hemodialysis centers.

Background
Reports indicate that those most vulnerable to developing severe coronavirus disease 2019 (COVID-19) are older adults and those with underlying illnesses, such as diabetes mellitus, hypertension, or cardiovascular disease, which are common comorbidities among patients undergoing maintenance hemodialysis. However, there is limited information about the clinical characteristics of hemodialysis patients with COVID-19 or about interventions to control COVID-19 in hemodialysis centers.

Methods
We collected data retrospectively through an online registration system that includes all patients receiving maintenance hemodialysis at 65 centers in Wuhan, China. We reviewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 between January 1, 2020 and March 10, 2020.

Results
Of 7154 patients undergoing hemodialysis, 154 had laboratory-confirmed COVID-19. The mean age of the 131 patients in our analysis was 63.2 years; 57.3% were men. Many had underlying comorbidities, with cardiovascular disease (including hypertension) being the most common (68.7%). Only 51.9% of patients manifested fever; 21.4% of infected patients were asymptomatic. The most common finding on chest computed tomography (CT) was ground-grass or patchy opacity (82.1%). After initiating comprehensive interventions—including entrance screening of body temperature and symptoms, universal chest CT and blood tests, and other measures—new patients presenting with COVID-19 peaked at 10 per day on January 30, decreasing to 4 per day on February 11. No new cases occurred between February 26 and March 10, 2020.

Conclusions
We found that patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high-risk settings during the epidemic. Increasing prevention efforts, instituting universal screening, and isolating patients with COVID-19 and directing them to designated hemodialysis centers were effective in preventing the spread of COVID-19 in hemodialysis centers.