Abstract
Patients with end-stage kidney disease experience some of the highest rates of COVID-19 disease. Alongside demographic and cardio-metabolic risks, those receiving in-centre haemodialysis (ICHD) treatment face a unique set of challenges surrounding the requirement to regularly attend for life-extending treatment, thereby preventing self-isolation. We aimed to characterise the impact of community disease burden, dialysis unit attributes and the range of infection control strategies, on rates of COVID-19 disease among patients receiving ICHD in London, UK. We used data collected by the Pan-London COVID-19 Renal Audit Group which included all adult patients receiving long-term ICHD provided by all seven London renal centres on 2 March 2020. A discrete-time multi-variable multi-level time-to-event analysis was used to examine associations with the risk of testing positive for SARS-Cov-2 infection, and admission to hospital with COVID-19 over 13 weeks. Data on 5,755 patients dialysing in 51 ICHD units from the 7 London renal centres were analysed. Of these, 981 (17.0%) patients tested positive and 465 (8.2%) were admitted with suspected COVID-19. Alongside established risk factors for disease, we observed a strong relationship between ICHD infection rates and rates reported in patients’ local communities. In addition, dialysis unit size was associated with outcomes, as was layout, specifically the number of side rooms (hazard ratio, HR: 0.86, 95%CI: 0.80 to 0.93 for test positivity or admission per side room/20 stations). Reduced risk of admission was observed two weeks following institution of mask wearing in asymptomatic patients (HR: 0.63, 95%CI: 0.43 to 0.93). Rates of staff illness paralleled that of patients, but no associations were seen between rates of disease in patients and the different units’ mitigation strategies. Figure: Geographical distribution of cases by dialysis unit by week for the first 8 weeks of the pandemic and at the final follow-up week. Each ICHD unit is represented by a circle. Circle size: number of patients dialysed; Circle colour: cumulative proportion of patients test positive for COVID-19 or admitted with suspected COVID-19. Underlying green intensity reflects number of cases in each middle layer super output area (not necessarily reflective of patients' home locality as, most, but not all, patients dialyse in their closest unit). Three units are not represented as they fall outside the area of the map. Dates represent the first day of the week represented.. These findings suggest the high risk of COVID-19 in the ICHD population relates to individual factors, and underlying community transmission, along with increased unit size and unfavourable unit layout. The results support interventions aimed at reducing transmission from asymptomatic patients and highlight the importance of preventing infection in nursing staff.
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