Early Adoption of COVID-19 Control Measures at a Large Urban Dialysis Center

During the coronavirus disease 2019 (COVID-19) epidemic, requirements for social distancing were instituted in many countries, including England. Patients with end-stage renal disease requiring dialysis in settings not typically conducive to social distancing are at increased risk for COVID-19. Richard W. Corbett, Bm BCh, and colleagues at the West London Renal and Transplant Centre described control measures implemented at the center during the COVID-19 epidemic in the Journal of the American Society of Nephrology [doi.org/10.1681/ASN.2020040534.]

The center recorded new COVID-19 infections and outcomes for all adult patients receiving dialysis over a 6-week period. The control methods introduced included a two-stage routine screening process at dialysis entry (temperature and symptom check, with possible cases segregated within the unit and tested for SARS-CoV-2), isolated dialysis in a separate unit for patients with infections, and universal precautions such as masks for dialysis nursing staff.

Of the 1530 patients (median age 66 years; 58.2% men) treated with dialysis at the center during the 6-week period, 19% (n=300) developed COVID-19 infection; resulting in a large demand for isolated outpatient and inpatient beds. In an analysis that included 1219 patients attending satellite dialysis clinics, older age was a risk factor for infection. Compared with patients dialyzing at home, patients receiving in-center dialysis were substantially more likely to develop COVID-19 infection. There were clusters of infection in specific units and on specific shifts, with possible implications for aspects of service design; there were also high rates of nursing staff illness.

A reproduction number of 2.2 was estimated from a predictive epidemic model. There was a favorable deviation in cumulative cases from the model from the fourth week, suggesting that transmission was controlled with the implemented measures.

In summary, the researchers said, “The COVID-19 epidemic affected a large proportion of patients at this dialysis center, creating service pressures exacerbated by nursing staff illness. Details of the control strategy and characteristics of this epidemic may be useful for dialysis providers and other institutions providing patient care.”