Covid-19 and Kidney Disease: Important Update for Kidney Patients

SARS-CoV-2 disease (COVID-19) primarily manifests as a lung infection with symptoms ranging from those of a mild upper respiratory infection to severe pneumonia, acute respiratory distress syndrome, and death. Kidney disease is a common chronic disease. The patients with kidney disease who appear most at risk for COVID-19 are those who undergo in-centre haemodialysis treatments thrice weekly, due to inability to self-isolate and patients with kidney transplant, due to immunosuppression. Patients with kidney disease also have other comorbidities, including hypertension, diabetes mellitus, and cardiovascular disease, that are risk factors for poor outcomes in COVID-19. People on dialysis have weaker immune systems, making it harder to fight infections.

• Studies done in dialysis patients with COVID-19 showed that dialysis patients with COVID-19 may not have fever and cough and they can present sometimes only with lack of appetite and fatigue.
• Patients with Kidney failure has a more severe disease course than general population with higher rates of complications like shock, lung and cardiac issues.
• Patients on regular haemodialysis must go to all dialysis treatments as missing even one treatment can make them very sick or lead to death.
• Precautions at dialysis units to prevent spread of COVID-19:

1. Checking all patients who come into the dialysis units for signs (temperature and oxygen saturation) and symptoms (fever, cough) of COVID-19 
2. Informing dialysis units prior to scheduled dialysis session upon having symptoms of COVID-19 and exposure to coronavirus 
3. Universal masking
4. Physical distancing between each dialysis patient during dialysis sessions
5. Frequent hand hygiene
6. Keeping all patients who show any signs of illness at a safe distance from other patients
7. Strict methods of cleaning and disinfecting the entire treatment area, including machines and other surfaces
8. Rapid testing of patients suspected to have infection

• Patients with COVID-19 with normal kidney function before the illness can develop abnormality in kidney function which is called acute kidney injury (AKI).
• COVID-19 can affect Kidney by Kidney tubular injury (acute tubular necrosis) with septic shock, microinflammation, increased blood clotting, and probable direct infection of the kidney.
• Incidence rates of AKI is 15% of hospitalized patients and 20% and higher in ICU patients with many requiring dialysis treatments.
• Patients with AKI have severe COVID-19 infection and higher death rates.
• Patients who developed AKI and patients with blood or protein in urine during illness with COVID-19 should follow up with Nephrologist after recovery as there is increased risk of Chronic Kidney Disease (CKD) in these patients on long term

• Patients with kidney disease (CKD, autoimmune diseases) and those who underwent kidney transplant are on multiple medications like blood pressure lowering medications, immunosuppressants etc.
• Immunosuppressive medicines (these work by keeping the immune system less active) can make it harder for the body to fight infections
• People with an autoimmune disease (example - Lupus nephritis) may be prescribed certain immunosuppressive medicines which should be continued
• Blood pressure medications called angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) should NOT be stopped. Stopping them could lead to a heart attack, stroke, or decreased kidney function.
• Patients with kidney transplants should not stop taking their immunosuppressants or lower their dose. Doing that will most likely lead to the loss of your donated kidney
• Keep taking any medicine as prescribed, wash your hands, maintain good hygiene, practice physical distancing, seek early care in case of new symptoms and follow recommendations by your health care provider