COVID-19 from the nephrologist's point of view

During the actual pandemic of COVID-19, it has become clear that the virus causing this devastating disease, SARS-CoV2, targets not only the lungs but also other organs. In this article, we discuss the known or suspected interactions between the virus and the kidneys, as well as their clinical presentations. We also discuss how the pandemic has altered the activities of nephrologists and the logistics of a Swiss dialysis center.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Withdrawal from dialysis in Switzerland between 2014 and 2021

Background: A recent Dutch study suggests that dialysis withdrawal has increased over the last years. The aims of this study were to investigate whether this is also the case in Switzerland, and to identify factors associated with withdrawal. Methods or Case description: In this retrospective study, data were retrieved from the Swiss Dialysis Registry (srrqap). Annual death rates and causes of death were analyzed between 2014-2021. We compared clinical characteristics of patients who were withdrawn for medical/other reasons or who withdrew from dialysis with those who had another cause of death and with those who stayed alive. Results or Learning points: A total of 7'246 incident patients on hemodialysis or peritoneal dialysis between 2014-2021 were included;of those, 2'325 patients died. In 2020, there was an above-average number of deaths, due to the coronavirus pandemic. Dialysis withdrawal because the patient refused further treatment represented 8.3-13.3% of all causes of death. Withdrawal by the patient did not increase throughout the study period, but withdrawal for medical/other reasons increased from 6.2 to 8.9% (see figure). Patients who died because of withdrawal from dialysis were significantly older and longer on dialysis than those with other causes of death, and had suffered less often from COVID-19. In multivariate regression analysis adjusted for age, sex, and Charlson score, testing negative for coronavirus was the only factor associated with withdrawal by the patient, whereas withdrawal for medical or other reason was also associated with higher age. Conclusion(s): Unlike the Netherlands, dialysis withdrawal is not the leading cause of death in Switzerland, and withdrawal by the patient has not increased, not even during the COVID-19 epidemic. However, the percentage of patients who was withdrawn for medical/other reasons increased during this period, for unclear reasons. The only risk factors for withdrawal were higher age and - surprisingly - testing negative for the coronavirus.

COVID-19 from the nephrologist’s point of view

During the actual pandemic of COVID-19, it has become clear that the virus causing this devastating disease, SARS-CoV2, targets not only the lungs but also other organs. In this article, we discuss the known or suspected interactions between the virus and the kidneys, as well as their clinical presentations. We also discuss how the pandemic has altered the activities of nephrologists and the logistics of a Swiss dialysis center.

COVID-19 pandemic in dialysis patients: The Swiss experience

Background: Chronic dialysis patients are classified as patients with increased risk for COVID-19. Knowledge about the incidence and survival of chronic dialysis patients infected with SARS-CoV-2 in Switzerland-a high-income country with high density of relatively small dialysis centers-is scarce. We present the findings regarding incidence, survival and regional differences, compared to those of the general population in Switzerland. Methods: Information on chronic dialysis patients who tested positive for SARS-CoV-2 between February 24, 2020 and January 31, 2021 were reported to the Swiss dialysis registry by all 95 Swiss dialysis centers. Hereafter, these results were linked with clinical characteristics from the Swiss dialysis registry. Results: Throughout the study period 573 dialysis patients tested positive for SARS-CoV-2 in Switzerland: 96 cases occurred in the first wave, 472 in the second wave and 5 in between. During the first wave, Italian-speaking Ticino was most severely affected, with a 7-fold higher incidence compared to the general Swiss population. In the second wave, the majority of cases were found in the French-speaking part of Switzerland, with a 2.5 times higher incidence versus non-dialysis patients. A total of 123 deaths were recorded, of which COVID-19 was the main cause of death in 100 patients. This corresponds to a highly increased overall mortality rate of 17.5% compared to 1.7% in the general population. None of the 40 patients with a history of renal transplantation died. Age was identified as the only independent risk factor for mortality in dialysis patients. Conclusions: Chronic dialysis patients in Switzerland are more likely to be infected by SARS-CoV-2 than the rest of the population, with large regional differences. Mortality is significantly increased compared to non-dialysis patients, albeit slightly less than in some other European countries.