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      COVID-19 Prevention and Control in Dialysis Centers during the Pandemic: A Single-Center Experience


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          Coronavirus disease (COVID-19) is highly contagious and is now a tragic pandemic. Maintenance hemodialysis (MHD) patients are susceptible to COVID-19 and more prone to develop into severe cases because of the older age, heavy comorbidities, and impaired immunity. Patients who receive in-center dialysis have to travel to and from dialysis centers; patients have to share the dialysis hall with others during dialysis, making the prevention and control of COVID-19 in dialysis centers different from that in community and more difficult. This article provides key points in coping with COVID-19 in dialysis centers during this pandemic based on experience: (1) enforcing infection control management of dialysis centers, (2) training of hemodialysis patients and medical staffs, (3) screening for COVID-19 among patients and medical staffs, and (4) providing graded isolated dialysis to close contacts, suspected cases, and confirmed cases of COVID-19. We hope our single-center experience can be referenced by other dialysis centers around the world in coping with the COVID-19 pandemic.

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          Most cited references13

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          Comorbidities and multi-organ injuries in the treatment of COVID-19

          “We now have a name for the disease caused by coronavirus and it's COVID-19”, said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO on Feb 11, 2020. 1 WHO recently updated the name novel coronavirus pneumonia, previously named by Chinese scientists, 2 to coronavirus disease 2019 (COVID-19). More attention should be paid to comorbidities in the treatment of COVID-19. In the literature, COVID-19 is characterised by the symptoms of viral pneumonia such as fever, fatigue, dry cough, and lymphopenia. Many of the older patients who become severely ill have evidence of underlying illness such as cardiovascular disease, liver disease, kidney disease, or malignant tumours.3, 4, 5 These patients often die of their original comorbidities; we therefore need to accurately evaluate all original comorbidities of individuals with COVID-19. In addition to the risk of group transmission of an infectious disease, we should pay full attention to the treatment of the original comorbidities of the individual while treating pneumonia, especially in older patients with serious comorbid conditions. Not only capable of causing pneumonia, COVID-19 may also cause damage to other organs such as the heart, the liver, and the kidneys, as well as to organ systems such as the blood and the immune system.3, 4, 5 Patients eventually die of multiple organ failure, shock, acute respiratory distress syndrome, heart failure, arrhythmias, and renal failure.5, 6 We should therefore pay attention to potential multi-organ injuries and the protection and prevention thereof in the treatment of COVID-19. We took over a ward for the centralised treatment of severely ill patients in Wuhan Tongji Hospital. 60 patients were classified into three types during their treatment. 13 [22%] of 60 patients mainly had pneumonia and were classified as type A. Basic treatments were provided, such as antivirals, antibiotics, oxygen therapy, and glucocorticoids. 33 (55%) of 60 patients were type B, with disease that manifested with different degrees of pneumonia, accompanied by serious comorbidities. For patients classified as type B, we continued to monitor the changes of comorbidities while managing the pneumonia, carrying out individual evaluations and developing specific treatment plans, including antihypertensives, hypoglycaemic therapy, and continuous renal replacement therapy. 14 (23%) of 60 patients were critically ill and were classified as type C. Patients classified as type C had disease that was considered to have developed from the aggravation of disease seen either in type A or type B, when early therapeutic effects for type A disease were unsatisfactory (resulting in multiple organ injuries), or when disease associated with type B became aggravated and the patient's condition deteriorated from their original comorbidities (leading to multiple organ failure). Attention should be paid to organ function in these critically ill patients and necessary protective measures, including mechanical ventilation, glucocorticoids, antivirals, symptomatic treatments, and anti-shock therapy. We believe that the classification of COVID-19 in severe patients could help in individual evaluation of the disease and would provide effective triage for the treatment and management of individual patients.
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            Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres

            Abstract COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.
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              The systemic nature of CKD

              Chronic kidney disease (CKD) affects numerous organs and systems, which in turn have effects on kidney function. This Review provides an overview of CKD as a systemic disease and discusses the multidirectional links between the kidney, bone, nervous and immune systems, and metabolism.

                Author and article information

                Blood Purif
                Blood Purif
                Blood Purification
                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 )
                26 May 2021
                : 1-6
                Department of Nephrology, Peking University People's Hospital, Beijing, China
                Author notes
                Copyright © 2021 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.

                : 29 March 2020
                : 2 March 2021
                Page count
                Figures: 1, References: 15, Pages: 6

                coronavirus disease 2019,hemodialysis,end-stage kidney disease,pandemic,preventive measures


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