Diffuse alveolar damage and acute respiratory failure have been reported to be the main features of COVID-19, however, limited information is available about the kidney disease in patients with COVID-19. Chronic kidney disease stage-5 (CKD-5) patients on dialysis or continuous ambulatory peritoneal dialysis are also vulnerable group because of their existing comorbidities.

General preventive methods in kidney patients

General management

• All the patients with confirmed COVID-19 should be quarantined.
• Not all patients need hospital admission.
• High-risk patients, or those with severe infection need admission in isolation units in designated hospitals
• Supportive care including bed rest, nutritional and fluid support, maintenance of hypertension and oxygenation are important measures is recommended for all critically ill patients
• Patients on regular dialysis should adhere to prescribed schedule and not miss their dialysis sessions to avoid any emergency dialysis. There are three situations when patients require dialysis;

o Patients already on maintenance dialysis

o Patients requiring dialysis due toa cute kidney injury (AKI)

o Patients critically ill requiring continuous renal replacement therapy

Management of patients during dialysis

• All patients should have their temperature monitored on arrival for dialysis
• Patients and accompanying persons should be given hands-free hand sanitizer while entering the dialysis room
• Patients who have fever or respiratory symptoms should call their dialysis unit before arrival, their assessment should be conducted in a room or area separate from the dialysis area and should be screened for COVID-19 infection. Patients with suspected coronavirus infection should receive: Fixed Dialysis Care Model” during the 14-day period of quarantine.
• If a new confirmed or highly suspected case of COVID-19 infection in dialysis centre is identified, disinfection should be carried out immediately.
• The medical waste from confirmed or suspected patients with COVID-19 infection should be considered as infectious medical wastes and disposed accordingly.

Resource:

1. Recommendations for the Novel Coronavirus 2019 Epidemic. International Society of Nephrology. Accessed from: https://www.theisn.org/covid19/recommendations Accessed on: April 15 2020.
2. American Society of Nephrology. Information for Screening and Management of COVID-19 in the Outpatient Dialysis Facility. Accessed from https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed on: April 15 2020.
3. Cheng Y, Luo R, Wang K, Zhang M, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International. 2020. Article in Press. Accessed from: https://www.kidney-international.org/article/S0085-2538(20)30255-6/pdf Accessed on: April 15 2020.
4. Guidelines for dialysis of COVID-19 patients. Ministry of Health and Family welfare. Government of India. 2020. Accessed from: https://www.mohfw.gov.in/pdf/GuidelinesforDialysisofCovid19Patients.pdf Accessed on: April 15 2020.