Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic.

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.

Recommendations for prevention and management of COVID-19 in peritoneal dialysis patients.

The World Health Organization characterized coronavirus disease (COVID-19) as a pandemic on March 11, 2020. Peritoneal dialysis patients have a weakened immune system that is associated with a high morbidity of infection. Thus, COVID-19 prevention measures and management for patients on peritoneal dialysis are urgent and critical. Based on published research on COVID-19 and previous clinical practices for similar coronavirus outbreaks, we aimed to make recommendations to manage patients undergoing peritoneal dialysis.