De-isolation of COVID-19-positive hemodialysis patients in the outpatient setting: a single-center experience.

Abstract

To the editor: The advice for patients presenting with COVID-19 symptoms is to self-isolate for 7 days after the onset of symptoms for the individual case, and 14 days for the household 1 . Dialysis patients can be considered as immuno-compromised and display a decreased ability to develop seroconversion to infectious diseases 2 . Therefore, 7-14 days may not be an appropriate threshold in a dialysis population. In our centre, we provide dialysis in 2 hospital-based and 6 satellite units, for a total of 664 patients. We cohorted our COVID-19 positive dialysis outpatients in a dedicated unit and followed a pathway for de-escalation of stable patients using serial COVID-19 swabs, starting 7 days after confirmed diagnosis (Figure 1 ). (Supplementary Table S1). 34 COVID-19 positive patients who had at least 3 swabs were included: 20 patients were de-isolated in less than 14 days (59%) with 9% on day 9. By day 12, 35% of patients could be dialysed in their base unit (which is crucial for capacity). However, by day 15, 14 patients (41%) had not cleared the virus and could not be repatriated: 5 patients cleared the virus later (median of 18 days (range 16-21)) and 9 patients were still positive or had only one negative swab at the end of follow-up. It is unclear if detection of viral RNA represents the ability to transmit the virus 3 , 4 , but until more evidence is available, it would be prudent to isolate patients as discussed to prevent cross-contamination in this high-risk population. Figure 1 De-escalation plan for COVID-19 positive dialysis patients, HD; Haemodialysis Disclosures Dr. Simon Goldenberg reports personal fees from Astellas, personal fees from Enterobiotix, personal fees from Menarini, personal fees from MSD, personal fees from Pfizer, personal fees from Shionogi, outside the submitted work.