ABSTRACT
INTRODUCTION: Following the first wave of COVID-19 there have been several variants. We wished to review the number and severity of infections with the different variants in a population of hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: We reviewed the outcomes and results in HD and PD patients testing positive for COVID-19 between March 2020 and August 2022. RESULTS: Seven hundred and ninety-five cases of COVID-19 were recorded in 710 dialysis patients. More HD patients than PD contracted wild type (21.4% vs. 6.8%), delta (23.3% vs 6.3%), and omicron (27.7% vs. 14.7%), all p < 0.01, but no difference with alpha (4.6% vs. 6.3%) or beta variants (5.7% vs. 6.85%). Hospitalization and death were greatest for alpha followed by wild type, beta, delta, and omicron (60.6% vs. 57% vs. 47.5% vs. 21.2% vs. 19.3%), respectively, p < 0.001. C reactive protein progressively increased from outpatient management to hospitalization to hospitalization with critical care or death (14 (4-30) vs. 41 (18-101) vs. 94 (47-168) mg/L, p < 0.001. Despite previous infection and vaccination 85 (12%) patients had two or more infections with COVID-19. CONCLUSION: Disease severity declined and survival improved as the virus mutated from wild-type and alpha to beta, delta, and omicron variants. Whether this related to reduction in viral virulence, vaccination, natural acquired immunity, or introduction of pharmacological treatments remains to be determined. Government lockdowns and enhanced infection control measures reduced the percentage of HD patients contracting alpha and beta variants to that of PD. Vaccination and prior infection did not prevent reinfection.
ABSTRACT
AIMS: Hemodialysis (HD) patients are at increased risk of respiratory infections, due to increased use of communal travel, waiting areas, close proximity to others when dialysing, and contact with healthcare personnel. We wished to determine the major factors associated with transmission of COVID-19 within dialysis centres. METHODS: We compared the differences in the number of COVID-19 infections in patients and staff in 5 dialysis centres during the 1st COVID-19 pandemic between March and June 2020, and analyzed differences between centres. Isolation policies and infection control practices were identical between centres. RESULTS: 224 (30.3%) patients tested positive for COVID-19, by reverse transcriptase polymerase chain reaction, ranging from 4.8% (centre 1 size 55 patients) to 41.5% (centre 5-248 patients) p = 0.007. Communal transport had a significant effect; with 160 of 452 (35.4%) patients using communal testing positive compared to 22.2% of those not using communal transport (X214.5, p < 0.001). Staff sickness varied; 35 of 36 (97.3% centre 5) dialysis staff contracting COVID-19, compared to 60% from centre 4 (189 patients 30 staff) (p < 0.001). Whereas centre 5 had no natural ventilation, and fan assisted ventilation did not meet standards for air changes and air circulation, centre 4 met ventilation standards. CONCLUSIONS: Although there are many potential risk factors accounting for the increased risk of COVID-19 infection in hemodialysis patients, we found that differences in communal transport for patients and ventilation between centres was a major contributor accounting for the differences in patients testing positive for COVID-19 and staff sickness rates. This has important practical applications for designing kidney dialysis centres.