Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective from the Spanish Nephrology

Background The recent SARS-CoV-2 coronavirus pandemic has signified a significant effect on the health of the population worldwide. Patients on chronic RRT have been affected by the virus, and they are at higher risk due to the frequent comorbid conditions. Here, we show the results of the COVID-19 Registry of the Spanish Society of Nephrology during the first 6 weeks of the outbreak. Methods This study is an analysis of the data recorded on a registry of patients with ESKD on RRT who tested positive for COVID-19. The aim was to evaluate clinical conditions, therapeutic management, and consequences, including outcome. The registry began on March 18th, 2020. It includes epidemiologic data, cause of CKD, signs and symptoms of the infection, treatments, and outcomes. Patients were diagnosed with SARS-CoV-2 infection on the basis of the results of PCR of the virus obtained from nasopharyngeal/oropharyngeal swabs. The tests were performed on symptomatic patients and on those who mentioned contact with infected patients. Results As of May 2, the registry included data on 1397 patients (in-center hemodialysis [IC-HD], 63%; kidney transplant [Tx], 34%; peritoneal dialysis [PD], 3%; and home hemodialysis, 0.3%). The mean age was 67 +/- 15 years, and two-thirds were men. Dialysis vintage was 46 +/- 41 months, and the time after transplantation was 59 +/- 54 months. Eighty-five percent of the patients required hospital admission, and 8% had to be transferred to intensive care units. Overall mortality was 25% (IC-HD, 27%; Tx, 23%; and PD, 15%), and significant proportions of deceased patients have advanced age, are on IC-HD, and presented pneumonia. Age and pneumonia were independently associated with the risk of death. Conclusions SARS-CoV-2 infection affected a significant number of Spanish patients on RRT, mainly those on IC HD. Hospitalization rates and mortality were high. The factors more closely related to mortality were age and pneumonia.