De-isolation of COVID-19–positive hemodialysis patients in the outpatient setting: a single-center experience
Authors: Caroline Dudreuilh, Nicola Kumar, Vicki Moxham, Carolyn Hemsley, Simon Goldenberg, Dimitrios-Anestis Moutzouris
Journal: Kidney International (2020)

The advice for patients presenting with coronavirus disease 2019 (COVID-19) symptoms is to self-isolate for 7 days after the onset of symptoms for the individual case and 14 days for the household.1Ahmed F. Zviedrite N. Uzicanin A. Effectiveness of workplace social distancing measures in reducing influenza transmission: a systematic review.BMC Public Health. 2018; 18: 518Crossref PubMed Scopus (270) Google Scholar Dialysis patients can be considered as immunocompromised and display a decreased ability to develop seroconversion to infectious diseases.2Baragetti I. El Essawy B. Fiorina P. Targeting immunity in end-stage renal disease.Am J Nephrol. 2017; 45: 310-319Crossref PubMed Scopus (22) Google Scholar Therefore, 7 to 14 days may not be an appropriate threshold in a dialysis population. In our center, we provide dialysis in 2 hospital-based and 6 satellite units, for a total of 664 patients (see Supplementary Methods). We isolated our COVID-19–positive dialysis outpatients in a dedicated unit and followed a pathway for de-escalation of stable patients with serial COVID-19 swabs, starting 7 days after confirmed diagnosis (Figure 1, Supplementary Table S1). Thirty-four COVID-19–positive patients who had at least 3 swabs were included: 20 patients were de-isolated in less than 14 days (59%) with 9% on day 9. By day 12, 35% of patients could be dialyzed in their base unit (which is crucial for capacity). However, by day 15, 14 patients (41%) had not cleared the virus and could not be repatriated: 5 patients cleared the virus later (median of 18 days [range, 16–21]) and 9 patients were still positive or had only one negative swab at the end of follow-up. It is unclear whether detection of viral RNA represents the ability to transmit the virus,3To K.K. Tsang O.T. Leung W.S. et al.Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.Lancet Infect Dis. 2020; 20: 565-574Abstract Full Text Full Text PDF PubMed Scopus (2327) Google Scholar,4He X. Lau E.H.Y. Wu P. et al.Temporal dynamics in viral shedding and transmissibility of COVID-19.Nat Med. 2020; 26: 672-675Crossref PubMed Scopus (2926) Google Scholar but until more evidence is available, it would be prudent to isolate patients as discussed to prevent cross-contamination in this high-risk population. SG reports personal fees from Astellas, Enterobiotix, Menarini, MSD, Pfizer, and Shionogi, outside of the submitted work. All the other authors declared no competing interests. Download .pdf (.23 MB) Help with pdf files Supplementary File (PDF) COVID-19: clinical course and outcomes of 36 hemodialysis patients in SpainKidney InternationalVol. 98Issue 1PreviewSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia emerged in Wuhan, China in December 2019. Unfortunately, there is a lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), and even less is available in patients on maintenance hemodialysis therapy than in the general population. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of all maintenance hemodialysis patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real-time polymerase chain reaction. Full-Text PDF A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infectionKidney InternationalVol. 98Issue 1PreviewThe SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Full-Text PDF COVID-19 in dialysis patients: adding a few more pieces to the puzzleKidney InternationalVol. 98Issue 1PreviewMaintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19) and its complications, owing to the presence of multiple comorbid conditions. The logistical aspects within a dialysis facility further increase the risk of disease transmission.1 Despite these obvious concerns, early reports from the epicenter of the disease—Wuhan, Hubei Province in China—suggested that the incidence of COVID-19 was lower than expected, with potentially a milder course and outcomes in MHD patients. Full-Text PDF