COVID-19 infections in a small dialysis organization in New York City

ABSTRACT

Background: COVID-19 infected more than 1.6 million Americans (0.48%) and more than 15,000 of the 500,000 (3%) Americans with chronic kidney disease treated by dialysis. The Rogosin Institute operates nine dialysis centers in New York City (NYC), the epicenter of the COVID-19 US Public Health Emergency (PHE). We followed guidance from the Centers for Disease Control and Prevention and the New York State Department of Health throughout the PHE. We screened all patients and staff for signs and symptoms of COVID-19 by measuring temperature and inquiring about symptoms on presentation to our dialysis centers. Infected patients who did not require hospitalization were treated in our centers on a dedicated shift by dedicated staff. We used a symptom-based approach to discontinuing isolation. Methods: We created a COVID-19 tool in REDCap to track the spread of Coronavirus. We surveyed our Electronic Health Record weekly using a direct data connection and automated scripting to identify patients infected with COVID-19. We reviewed demographic and clinical data for each infected patient. We used descriptive statistics to analyze our population of infected patients. Results: On February 28, 2020, 1,559 patients received dialysis at our centers. By May 11, 241 (15.5%) had been infected. Our mortality rate was 22.8% compared to general populations in NYC (10-12%), US (6.0%) and worldwide (6.5%) and rates for dialysis patients reported between 7-20%. We had a disproportionate occurrence of COVID-19 among residents of Brooklyn (49% of infections, 44% of patients) and Queens (29%;25%). Most of the infected patients were male (53%) and Black (51%). Common co-morbidities included hypertension (98%), diabetes mellitus (60%), heart failure (25%) and coronary artery disease (25%). Common outpatient medications included statins (64%) ACE inhibitors/ARBs (80%) and calcium channel blockers (63%). Fever was the only common presenting symptom (94% of patients). A significant proportion (12%) of patients were in the hospital within 14 days prior to diagnosis of COVID-19 infection. Conclusions: COVID-19 infection was common and associated with high mortality rate in our NYC population of dialysis patients despite adherence to governmental guidelines for control of disease spread. We hypothesize community spread was common in our patients residing in the epicenter of the US COVID-19 PHE.