The management of medical care with dialysis methods in outpatients during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has changed the health care system for patients with CKD5. Dialysis patients are at particularly high risk of COVID-19, severe infection, and poor outcomes. Materials and methods: In 2020, in 86 FME RF clinics, 11 331 patients (54.1% - men) received dialysis treatment, 21.8% had DM, 10 717 patients were treated with HD and HDF methods, 614 patients were on PD, and 2854 employees provided medical care. The data were collected using the EuCliD database and statistically processed online at sites https://molbiol.kirov.ru and https://medstatistic.ru. Results: COVID-19 is more often detected in men, patients 40 to 79 y.o., in patients with DM. The rate of sick patients <50 y.o. (31.2% of all treated) was 22.8% of all infected and in the group>50 y.o. (68.8% of all treated), the rate of patients was 77.2%. There were no significant differences between the incidence of COVID-19 infection in groups ≥50 and <60 y.o., ≥60 and <70 y.o., ≥70 and <80 y.o., ≥80 y.o. COVID-19 positive patients (on HD and PD) who died in 2020 - 324 people, were 2.9% of all treated in 2020 and 31.6% of all infected dialysis patients. In FME RF clinics 18.6% and 18.4% of all patients in the RF were treated by HD and PD respectively, but the proportion of mortality from COVID-19 in FME RF clinics was 10.5% at HD and 11.0% at PD respectively. In dialysis centers, FME RF patients with COVID-19 on HD were 2.2 times less than in the dialysis population of RF as a whole (p<0.001), and on PD - 1.98 times less than in RF (p<0.001). In RF patients with COVID-19 on PD and HD, it was found that the mortality rate was significantly lower in patients on PD vs HD (p<0.001). There was no significant effect on the outcomes in COVID-19 patients depending on the method of treatment in FME RF clinics (p=0.349). Conclusion: Patients on dialysis are at greater risk of COVID-19 and fatal outcomes. The administrative, organizational, and medical work of FME RF led to positive results both in the prevention of infection and in treatment outcomes.

пандемия, организация медицинской помощи, диализ, pandemic, management of medical care, dialysis, CKD

1. van Doremalen N., Bushmaker T., Morris D.H. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020; 382(16): 1564-1567. doi:10.1056/NEJMc2004973.

2. Huang C., Wang Y., Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30]. Lancet. 2020; 395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.

3. Xu X., Chen P., Wang J. et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020; 63: 457-460. doi: 10.1007/s11427-020-1637-5.

4. Shimada N., Shimada H., Itaya Y., Tomino Y. Novel coronavirus disease in patients with end-stage kidney disease. Ther Apher Dial. 2021; 25(5): 544-550. doi:10.1111/1744-9987.13599.

5. Временные методические рекомендации: профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19), 10-я версия от 08.02.2021. - Минздрав России, 2021. C 261.

6. Guan W.J., Ni Z.Y., Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18): 1708-1720. doi:10.1056/NEJMoa2002032.

7. Keller N. Chantrel F. Krummel T. et al. Impact of first-wave corona virus disease 2019 infection in patients on haemodialysis in Alsace: The observational COVIDAL study. Neprol Dial Transplant. 2020; 35: 1338-1345. doi: 10.1093/ndt/gfaa170.

8. Fisher M., Yunes M., Mokrzycki M.H. et al. Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York. Kidney360. 2020; 1(8): 755-762. Published 2020 Jun 18. doi:10.34067/KID.0003672020.

9. Jordan R.E., Adab P., Cheng K.K. Covid-19: risk factors for severe disease and death. BMJ. 2020; Mar 26;368:m1198. doi: 10.1136/bmj.m1198.

10. Yang J., Zheng Y., Gou X. et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020; 94: 91-95. doi: 10.1016/j.ijid.2020.03.017.

11. Yang X., Yu Y., Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5): 475-481. doi: 10.1016/S2213-2600(20)30079-5.

12. Fu L., Wang B., Yuan T., Chen X. et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect 2020. 2020; 80(6): 656-665. doi: 10.1016/j.jinf.2020.03.041.

13. Goicoechea M., Camara L.A.S., Macias N. et al. COVID-19: Clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020; 98: 27-34. doi: 10.1016/j.kint.2020.04.031.

14. La Milia V., Bacchini G., Bigi M.C. et al. COVID-19 Outbreak in a Large Hemodialysis Center in Lombardy, Italy. Kidney Int Rep 2020; 5(7): 1095-9 doi: 10.1016/j.ekir.2020.05.019.

15. Trujillo H., Caravaca-Fontán F., Sevillano Á. et al. SARS-CoV-2 infection in hospitalized patients with kidney disease. Kidney Int Rep. 2020; 5: 905-909. doi: 10.1016/j.ekir.2020.04.024.

16. Alberici F., Delbarba E., Manenti C. et al. A report from the Brescia renal COVID task force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection. Kidney Int. 2020; 98(1): 20-6. doi: 10.1016/j.kint.2020.04.030.

17. Seidel M., Hoelzer B., Appel H. et al. Impact of renal disease and comorbidities on mortality in hemodialysis patients with COVID-19: A multicenter experience from Germany. J Nephrol. 2020; 33(5): 871-874. doi: 10.1007/s40620-020-00828-8.

18. Ma Y., Diao B., Lv X. et al. COVID-19 in hemodialysis (HD) patients: report from one HD center in Wuhan, China. medRxiv. (2020). doi: 10.1101/2020.02.24.20027201

19. Basile C., Combe C., Pizzarelli F. et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant. 2020; 35(5): 737-741. doi:10.1093/ndt/gfaa069.

20. Cheng Y., Luo R., Wang K. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020; 97(5): 829-838. doi:10.1016/j.kint.2020.03.005.

21. Valeri A.M., Robbins-Juarez S.Y., Stevens J.S. et al. Presentation and Outcomes of Patients with ESKD and COVID-19. J Am Soc Nephrol. 2020; 31(7): 1409-1415. doi:10.1681/ASN.2020040470.

22. Wu Y.C., Chen C.S. Chan Y.J. The outbreak of COVID-19: an overview. J Chin Med Assoc 2020; 83: 217-20. doi: 10.1097/JCMA.0000000000000270.

23. Tang B., Li S., Xiong Y. et al. COVID-19 pneumonia in a hemodialysis patient. Kidney Med. 2020; 2(3): 354-8. doi: 10.1016/j.xkme.2020.03.001.

24. Freitas G.R.R., da Luz Fernandes M., Agena F. et al. Aging and End Stage Renal Disease Cause A Decrease in Absolute Circulating Lymphocyte Counts with A Shift to A Memory Profile and Diverge in Treg Population. Aging Dis. 2019; 10(1): 49-61. Published 2019 Feb 1. doi:10.14336/AD.2018.0318.

25. Gagliardi I., Patella G., Michael A. et al. COVID-19 and the Kidney: From Epidemiology to Clinical Practice. Clin Med. 2020; 9(8): 2506. doi: 10.3390/jcm9082506.

26. Xiong F., Tang H., Liu L. et al. Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China. Journal of the American Society of Nephrology. 2020; 31(7): 1387-1397. doi: 10.1681/ASN.2020030354.

27. Naicker S., Yang C.W., Hwang S.J. et al. The novel coronavirus 2019 epidemic and kidneys. Kidney Int. 2020; 97(5): 824-828. doi: 10.1016/j.kint.2020.03.001.

28. Lee J.J., Hwang S.J., Huang J.F. Review of the present features and the infection control challenges of COVID-19 pandemic in dialysis facilities. Kaohsiung J Med Sci. 2020; 36(6): 393-398. doi:10.1002/kjm2.12239.

29. Syed-Ahmed M., Narayanan M. Immune Dysfunction and Risk of Infection in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2019; 26(1): 8-15. doi:10.1053/j.ackd.2019.01.004.

30. Шилов Е.М., Котенко О.Н., Шилова М.М. и др. Эпидемиология COVID-19 у больных, получающих заместительную почечную терапию в Российской Федерации: итоги 2020 г. Клиническая нефрология. 2021; 1:5-12.

31. Kliger A.S., Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities. Clin J Am Soc Nephrol. 2020; 15(5): 707-9. doi: 10.2215/CJN.03340320.

32. Ikizler T.A. COVID-19 and dialysis units: What do we know now and what should we do? Am J Kidney Dis. 2020; S0272-6386(20): 30608-30609. doi: 10.1053/j.ajkd.2020.03.008.

33. Рекомендации по организации противоэпидемического режима в медицинских организациях при оказании медицинской помощи населению в период сезонного подъема заболеваемости острыми респираторными инфекциями и гриппом в условиях сохранения рисков инфицирования новой коронавирусной инфекцией (COVID-19) МР 3.1 02.09.20. Москва 2020