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      De-isolation of COVID- positive haemodialysis patients in the outpatient setting: a single centre experience

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          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.

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          Targeting Immunity in End-Stage Renal Disease

           Ivano Baragetti,  Basset El Essawy,  Paolo Fiorina (corresponding) (2017)
          Background: Despite the stable incidence of end-stage renal disease (ESRD), it continues to be associated with an unacceptably high cardiovascular risk. Summary: ESRD is characterized by enhanced oxidative stress and severe inflammation, which boost cardiovascular risk, thus increasing cardiovascular-associated mortality rate. While substantial effort has been made in the technological innovation of dialytic techniques, few significant advances have been made to reduce inflammation in patients with ESRD. Indeed, this contrasts with the extensive scientific breakthroughs made in the basic field of science in targeting inflammation. There is thus a pressing need for clinical trials to test the effect of reducing inflammation in patients with ESRD. Here, we will revisit the negative effect of ESRD on inflammation and explore the impact of enhanced inflammation on cardiovascular outcomes and survival in patients with ESRD. Finally, we will discuss the need for clinical trials that target inflammation in ESRD, as well as weigh potential disadvantages and offer novel innovative approaches. Key Message: We will try to understand why the issue of inflammation has not been successfully addressed thus far in patients with ESRD, while at the same time weighing the potential disadvantages and offering novel innovative approaches for targeting inflammation in patients with ESRD.

            Author and article information

            Kidney Int
            Kidney Int
            Kidney International
            International Society of Nephrology. Published by Elsevier Inc.
            8 May 2020
            8 May 2020
            [1 ]Renal Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
            [2 ]Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
            Author notes
            []Corresponding Author Dr Dimitrios-Anestis Moutzouris Renal Department Guy’s Hospital Great Maze Pond London SE1 9RT UK Tel: 0207188 5664 dimitrios.moutzouris@
            © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

            Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.



            hemodialysis, inflammation, covid-19


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