key: cord-0730515-1vrmts8f
authors: Wang, Huiming
title: Maintenance Hemodialysis and Coronavirus Disease 2019 (COVID-19): Saving Lives With Caution, Care, and Courage
date: 2020-03-26
journal: Kidney Med
DOI: 10.1016/j.xkme.2020.03.003
sha: b1e3d37a0b80c574cc69a25922a0aad46a07a7af
doc_id: 730515
cord_uid: 1vrmts8f

nan

To the Editor:

The outbreak of coronavirus disease 2019 (COVID-19) first reported in Wuhan has become a global pandemic, posing a serious threat to human life and health, especially for those with pre-existing comorbid conditions, including kidney disease. [1] [2] [3] [4] [5] [6] Hemodialysis (HD) patients comprise a distinct population in the COVID-19 outbreak: (1) there is a relatively large number of HD patients; (2) HD facilities are widespread, scattered across Wuhan; (3) HD patients are mobile, traveling from home to dialysis facilities and other health care settings, serving as potential vectors for infection; (4) HD patients receive lengthy treatments in close proximity to other patients and dialysis staff; and (5) HD patients have impaired immune function. Accordingly, attention to HD patient management is critical for mitigating the COVID-19 pandemic.

Our HD facility at Renmin Hospital, Wuhan University, had an outbreak of COVID-19, beginning with confirmation of the first case on January 14, 2020. We summarize our experiences with COVID-19 through February 17, 2020, the day the first round of screening was completed. Several of these findings have also been reported in medRxiv. 7 First, we had 37 documented cases of COVID-19 among 230 (16.1%) HD patients and 4 cases among 33 (12.1%) staff. Second, it is our opinion that COVID-19 can be either prevented or controlled within an HD facility, and the key is to take effective measures early, including timely upgrading of personal protection measures and implementation of universal screening (Box 1), followed by quarantine and isolation as needed. We found that computed tomography of the chest was an appropriate screening test, given easy availability and high sensitivity. Third, we were surprised to find that although HD patients are susceptible to COVID-19 infection, most presented with either no symptoms or only mild clinical signs and symptoms. Although 7 HD patients died during the epidemic, including 6 with and 1 without COVID-19 infection, no patient died of severe pneumonia caused by COVID-19. Interestingly, the major cause of death was cardiovascular events, which seem to be related to insufficient dialysis due to patients missing HD sessions to avoid possible infection. In addition, we hypothesize that because of the chronic immune dysfunction seen in HD patients, SARS-Cov-2 infection did not trigger the inflammatory storm that appears to mediate clinical deterioration or death in many patients with COVID-19 infection. 8 In conclusion, although we found at our center that COVID-19 poses a serious threat to both staff and patients, planning and screening procedures can help contain COVID-19 and failure to dialyze may be more risky than receiving dialysis in a rigorous and well-prepared dialysis facility, emphasizing that preparation should trump fear when addressing COVID-19. 

World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report -31

National Health Commission of the Peoples Republic of China. COVID-19 epidemic situation report

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Clinical characteristics of 2019 novel coronavirus infection in China

A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units

World Health Organization, WHO characterizes COVID-19 as a pandemic

Novel coronavirus disease in hemodialysis (HD) patients: report from one HD center in Wuhan, China

Clinical features of patients infected with 2019 novel coronavirus in Wuhan