Prevention and Management of COVID-19 in Hemodialysis Centers

August 3, 2020

This article gives recommendations for individual hemodialysis centers worldwide to ensure the safety and effectiveness of patients receiving maintenance hemodialysis based on the experience of such a patient with coronavirus disease 2019 (COVID-19) in the Sichuan province of China.

Am J Manag Care. 2020;26(8):e237-e238. https://doi.org/10.37765/ajmc.2020.43887

Currently, coronavirus disease 2019 (COVID-19) has been effectively controlled in China, but it has spread to most of the globe, including Europe and America, and has been developing into a large-scale outbreak in many countries. While in the throes of this severe pandemic, “isolated observation or treatment at home” becomes a priority to avoid the spread and development of COVID-19.1 However, there is a special group of patients who may be ignored: those receiving maintenance hemodialysis (MHD). These patients cannot be isolated at home completely because they require routine treatment in the hemodialysis center, usually 3 times a week. At this time, they would come into contact with a large number of patients and medical staff in the dialysis center, which leads to a higher risk of contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Recently, some scholars have gradually paid more attention to these patients,2,3 but there are still few observational studies. Here, we analyze the treatment of a patient receiving MHD who had a new diagnosis of COVID-19 in Chengdu, Sichuan Province, China, and how the independent hemodialysis center in the community effectively prevented and controlled the spread of the disease.

On February 1, 2020, a hemodialysis patient in a primary hemodialysis center in Chengdu (with 60 dialysis machines and more than 200 MHD patients) informed the doctor that his family member had sought medical help due to fever and had subsequently received a diagnosis of COVID-19. The doctor determined that the patient was a high-risk contact of a COVID-19 case and made several suggestions to the patient: that he should stay home for observation; delay dialysis; and report the case to the hospital, the administration department of public health, and the CDC of the district immediately. The next day, the public health department of the district coordinated the referral of the patient to the Chengdu Public Health Center (a hospital that has isolation wards for dialysis treatment of patients with tuberculosis and HIV) for isolated dialysis treatment; there, he underwent chest CT and nucleic acid detection of SARS-CoV-2. The patient received a diagnosis of SARS-CoV-2 infection on February 4 and died on February 15.

After the patient was taken to the district referral hospital and confirmed to have COVID-19, 56 hemodialysis patients in the primary hemodialysis center who were on the same shift of dialysis or had made contact with the patient were listed as close contacts. However, at the time, Chengdu could not meet the requirements of isolated dialysis for 56 hemodialysis patients. After consultation and discussion, the administrative department of public health and the hospital took the following measures: (1) Patients remained in their initial hospital for dialysis and arrangements were made for them to receive dialysis in the same shift. (2) Patients were asked to isolate at home during the nondialysis period, and they were not allowed to take public transport to the hospital on the day of dialysis. (3) After patients arrived at the hospital, their body temperature and the epidemiological form (including whether there were any COVID-19 symptoms and suspected contact history) were recorded and verified by the doctor. (4) Until the previous shift of dialysis patients left completely, the patients could not enter the dialysis treatment room. (5) Medical masks were required during the entire dialysis treatment.

At the same time, the medical staff implemented strict hand hygiene policies and all members were required to use protective equipment, including surgical masks, face shields/goggles, protective gowns, medical caps, and gloves. Also, the administrative department of public health, in combination with the Sichuan provincial quality control center of kidney disease, launched an independent hemodialysis center with 10 isolated dialysis seats as a specialized dialysis unit for patients receiving MHD who had COVID-19 contact history. If COVID-19 was confirmed at the specialized dialysis unit, patients would be transferred to the hemodialysis center specifically set up for confirmed COVID-19 cases in Chengdu Public Health Center for dialysis. As of March 23, there were no new cases of COVID-19 in the primary hemodialysis center and no hemodialysis patients newly infected with SARS-CoV-2 around the Chengdu area.

We have gained some experience from a series of prevention and treatment measures due to the infected patients receiving MHD: (1) To know the patient’s situation as soon as possible, body temperature and the epidemiological form from all hemodialysis patients should be recorded before dialysis. (2) It is difficult to ensure adequate isolated dialysis seats for every MHD patient with contact history and suspected infection and to guarantee strict isolation at home and during travel. Accordingly, first-class protection was an effective measure to ensure the safety of medical staff, who are different from the staff on the isolation ward.4
(3) Both a “hemodialysis center for close contacts” and a “hemodialysis center for confirmed patients” should be established to control the spread of the epidemic if it is logistically possible. We hope to collect more data on patients receiving hemodialysis during the epidemic for further statistical analysis.

Author Affiliations: Department of Nephrology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China (YT, YL, FD), Chengdu, China; Hemodialysis Center, Chengdu Public Health Center (YX), Chengdu, China; Department of Nephrology, Jinniu District People’s Hospital, Sichuan Provincial People’s Hospital Jinniu Hospital (FD), Chengdu, China.

Source of Funding: This work was supported by National Natural Science Foundation of China (81700607 and 81770742), Foundation of Sichuan Academy of Sciences & Sichuan Provincial People’s Hospital (2018LY12), and Department of Science and Technology of Sichuan Province (2019YFH0069).

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (FD); acquisition of data (YT, YX); analysis and interpretation of data (YT, YX); drafting of the manuscript (YT); critical revision of the manuscript for important intellectual content (YL, YX, FD); statistical analysis (YL); provision of patients or study materials (FD); obtaining funding (YL, FD); administrative, technical, or logistic support (FD); and supervision (DF).

Address Correspondence to: Fei Deng, MBBS, Department of Nephrology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China. Email: dengfei@med.uestc.edu.cn.

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2. Kliger AS, Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities. Clin J Am Soc Nephrol. 2020;15(5):707-709. doi:10.2215/CJN.03340320

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