ABSTRACT
Background: People with kidney failure who are on facility-based hemodialysis (FBHD) are at high risk for COVID-19 infection due to inherent alterations in their immune system as well as the requirement to travel to a health care facility multiple times per week. In Alberta Kidney Care South, AKCS, public health measures and standardized screening of all patients entering clinics and HD units was initiated in March 2020 with COVID-19 testing of all patients who presented with a temperature, COVID related symptoms or a history of exposure to COVID-19. Methods: All COVID-19 test results performed for AKCS patients are tracked in the electronic kidney database. We performed a 14-month prospective observational study (March 2020 to May 2021) to determine the incidence of confirmed COVID-19 infections, the prevalence of symptoms amongst COVID + patients and outcomes of hospitalization and death for FBHD, home hemodialysis (HHD) and peritoneal dialysis (PD) patients within the Alberta Kidney Care South program. Results: We report on our preliminary results up to December 31, 2020. From a population of 1 329 patients, (931 FBHD, 102 HHD and 296 PD) 46(3.5%) patients were COVID positive. COVID-19 prevalence was 3.5% in FBHD (33/931), 4.4% in PD (13/296) and no HHD patients. The mean age of the cohort was 61 ± 16.5 years with 14(30%) female and comorbidities of hypertension 43(93%), diabetes 35(76%), coronary artery disease 16(35%) and heart failure 10(22%). COVID-19 testing was done for the following reasons: contact with a known COVID-19 person in 4(8.7%), resident of a long-term care facility in 3(6.5%) and for symptoms in 31(67%). The most common symptoms were fever (defined as T> 37.3C) with 20(43%), cough 10(22%) and sore throat 6(13%). Overall, 14 patients (30%) were admitted to hospital, 4 of whom went to the ICU and 5(11%) died. There were no differences in hospitalization between FBHD and PD (30% vs 31% respectively p = 0.971), ICU admissions (12% vs 0%, p=0.189) or death (12% vs 8 %, p=0.664). Conclusions: The prevalence of COVID-19 amongst FBHD and PD patients was similar to the general population but with higher rates of hospitalization, ICU admissions and death. People on HHD appear to have very low rates of COVID-19 as compared to either PD or FBHD.