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      Convalescent COVID-19 Patients on Hemodialysis: When Should We End Isolation?

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      Nephron. Clinical Practice

      S. Karger AG

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          Abstract

          Dear Editor, All hemodialysis facilities are putting extensive efforts to protect their patients from the COVID-19 pandemic. Screening for the symptoms is the first step of all. When there is fever, cough, or shortness of breath, the patient becomes a suspected case to be tested for COVID-19. Suspected and confirmed COVID-19 patients should ideally be dialysed in a separate isolation room [1]. When an isolation room cannot be established, these patients may be placed in the last shift or sent to a COVID-19 designated dialysis facility. The staff should follow institutional guidance to use appropriate personal protective equipment. All of the suggested algorithms necessitate isolation of patients when they are either suspected or confirmed COVID-19 cases [2]. Many institutions have established isolation rooms for dialysis, and experiences in this context are growing. As understanding of the disease evolves, we have more patients for whom a discharge is planned, and none of the guides has mentioned about the ideal timing to end the isolation for hemodialysis patients yet. The following are the generally accepted criteria to discharge patients from COVID wards: being afebrile for at least three consecutive days having two negative respiratory SARS-CoV2 PCR tests done 24 hours apart having improved respiratory symptoms with absorbed inflammation in imaging studies. Discharging a patient from a COVID ward may be relatively easy when compared to a nephrologist's dilemma to decide the best for both this particular patient and other hemodialysis patients. Should this patient be accepted to a standard facility as the PCR tests are negative? We know that RT-PCR done for SARS-CoV2 has 70% sensitivity [3] and it can miss some cases even if it is done twice. Although not extensively studied yet, viral shedding could be detected on the 37th day for SARS-CoV2, with a median of 20 days [4]. Besides, PCR assays may turn positive for some discharged patients [5]. In summary, we suggest that nephrologists should continue hemodialysis in an isolation room even if the patient is discharged. The use of relevant personal protective equipment should also be continued during this period. The decision to end the isolation should be given with an additional PCR test which is done 1 month after the patient was confirmed to have COVID-19. We believe that such an approach will be valuable to protect other patients as viral shedding may continue even if the patient is accepted to be convalescent. Disclosure Statement The authors have no conflicts of interest to declare. Funding Sources The authors did not receive any funding. Author Contributions Dr. Ahmet Murt conceptualized the idea, did the literature search, and wrote the manuscript. Prof. Mehmet Riza Altiparmak supervised the work and revised the text.

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          Most cited references 3

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          PCR Assays Turned Positive in 25 Discharged COVID-19 Patients

          Abstract We report the observation that 14.5% of COVID-19 patients had positive RT-PCR testing again after discharge. We describe correlations between laboratory parameters and treatment duration (r= -0.637; p=0.002) and time to virus recrudescence (r= 0.52; p=0.008) respectively, suggesting the need for additional measures to confirm illness resolution in COVID-19 patients.
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            On the Frontline of the COVID-19 Outbreak: Keeping Patients on Long-Term Dialysis Safe

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              PCR Assays Turned Positive in 25 Discharged COVID-19 Patients

               J. YUAN,  S. KOU,  Y LIANG (2021)
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                Author and article information

                Journal
                Nephron Clin Pract
                Nephron Clin Pract
                NEF
                Nephron. Clinical Practice
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH-4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1660-8151
                1660-2110
                19 May 2020
                : 1-2
                Affiliations
                Nephrology Unit, Internal Medicine Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
                Author notes
                *Dr. Ahmet Murt, Internal Medicine / Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Cerrahpasa, Istanbul 34098 (Turkey), ahmet.murt@ 123456istanbul.edu.tr
                Article
                nef-0001
                10.1159/000508380
                7270057
                32428901
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                References: 5, Pages: 2
                Categories
                Clinical Practice: Letter to the Editor

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