First of all, the disease itself can damage the kidneys. Secondly, the spread and isolation in dialysis units will be a problem. Thirdly, dialysis and transplant patients may succumb to it more easily.
What does the data from Wuhan show so far? The main causes of death for patients infected with COVID-19 are pneumonia and respiratory failure. Early reports from Wuhan showed only up to 9% kidney involvement in these patients. But a subsequent report covering 59 patients showed that 34% had a protein leak in urine on admission, which increased to 63% later. The kidney function was reduced in 27% of the patients and in two-thirds of those who died. Among the 710 hospitalised patients, 44% had a protein leak and 26% microscopic blood leak in urine.
The CT scan showed dense kidneys in those who died. The reason for this was the direct involvement of the kidneys with the virus and also the inflammatory toxins (cytokines) released in sick patients.
One interesting finding was that among the patients who were taking certain BP drugs like ARB and ACE inhibitors, the death rate was higher. The treatment of patients with kidney failure is not different from that of any other patient in ICCU, including dialysis or CRRT.
There are no reports on patients who are not on dialysis. There are 7,184 patients in 61 centres in Wuhan city. Only seven deaths have been reported, with 37 out of a total of 230 patients having been affected, besides four staff members. Reports from other centres are not available. In the affected patients, the disease seems to be milder. Dialysis centres are likely to spread the infection due to close spacing between patients and frequent visits by patients.
Both the Chinese Society of Nephrology and the Taiwanese Society of Nephrology have issued guidelines for dialysis units, including education and training of staff and patients, collection of travel data, isolation of suspected cases, use of cap mask, gowns and sanitisers, hand washing, disposal of waste, sterilisation of machines, increasing the distance between patients and cleaning and disinfection of units. It would be very difficult to follow these guidelines in India due to the total non-uniformity of dialysis units and the reuse of dialysers in many centres. Universal precautions should be followed in dialysis centres, irrespective of epidemics.
Transplant patients
There are no reports of COVID-19 in transplantation patients.
Though we expect kidney transplantation to have special concerns, immunosuppression late after transplantation may result in less severe manifestations of the disease. Obviously, these patients are required to follow the same precautions — hand washing, fewer visits to hospitals and avoidance of travel.
