Management
COVID-19 and Patients with Chronic Kidney Disease (CKD) and End-stage Renal Disease (ESRD)
Editors: Brad Denker MD; William Aird MD
Overview
- Coronavirus Disease 2019 (COVID-19) is an acute respiratory disease caused by novel coronavirus SARS-CoV-2 (Centers for Disease Control and Prevention 2020 Mar 22)
- patients with existing conditions can be more susceptible to COVID-19 and are likely to experience more severe illness, including patients with chronic kidney disease (CKD), patients on chronic dialysis, and those living with a kidney transplant
- kidney abnormalities associated with increased in-hospital mortality in patients with COVID-19; kidney abnormalities may include proteinuria, hematuria, elevated serum creatinine, elevated blood urea nitrogen, and estimated glomerular filtration rate (GFR) < 60 mL/minute/1.73 m2
- for patients with chronic kidney disease (CKD)
- CKD appears to be associated with severe COVID-19
- advise patients to remain on medications at prescribed doses, including angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) unless indicated otherwise by treating clinician
- management of patients with COVID-19 and with CKD treated with immunosuppressive therapy may depend on severity of COVID-19
- for patients on chronic dialysis
- management of patients on dialysis should be carried by strict adherence to protocols to minimize spread of infection
- strategies to mitigate risk and spread of COVID-19 infection in dialysis facilities include
- following policies and protocols that should already be in place to reduce spread of contagious respiratory pathogens
- early recognition and isolation of patients requiring dialysis if presenting with signs and symptoms consistent with respiratory infection; patients with symptoms must inform facility personnel prior to arrival and wear face mask at all times
- ensuring maintenance of distance (≥ 6 feet or ≥ 2 meters) between infected patients and those who are not infected at all times, including in waiting rooms and in treatment areas
- providing updated information on precautionary measures and tools (for example, alcohol-based hand-sanitizers and personal protection equipment) to protect both patient and personnel
- use of isolation rooms, if available, for treatment
- cohorting patients with suspected or confirmed COVID-19 infection and personnel caring for them together in 1 section of the unit or on same shift
- routine cleaning, disinfection, or disposal (if appropriate) of all surfaces, materials, and equipment, especially if they have come in close contact (within 6 feet or 2 meters) of infected patient
- patients on dialysis who have a family member or caregiver who is in quarantine as part of precautionary isolation (14 days), but not presenting with symptoms of infection, may undergo dialysis during quarantine period
- once family member or caregiver has been confirmed as having COVID-19 infection, patient must be upgraded and treated in accordance with those who are suspected of having COVID-19 infection
- for patients with kidney transplant
- kidney transplant recipients and patients using immunosuppressive therapy can be more susceptible to COVID-19 and are likely to experience more severe illness, and should take measures to prevent infection
- for management of kidney transplant patients with COVID-19 hospitalized with pneumonitis, might consider replacement therapy with methylprednisolone 16 mg and concurrent withdrawal of mycophenolate mofetil and azathioprine, calcineurin inhibitors, and mTOR inhibitors
- for patients with COVID-19 who develop acute kidney injury requiring renal replacement therapy, see also Acute Kidney Injury in Adults - Approach to the Patient
- see also COVID-19 for additional information
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