Global Reports

COVID-19 poses an unprecedented threat to the modern world. Every region of the globe is affected, and dialysis services are particularly hit, with an unwell older population at increased risk of infection and mortality. Most haemodialysis patients are dialysed in centre and hence these patients are unable to self isolate, substantially increasing their risk of infection. Peritoneal dialysis patients may be less affected as they are better placed to practice social isolation.

The nephrology workforce is stretched, with an increased workload in both outpatient dialysis and inpatient consults for acute kidney injury secondary to COVID-19 infection. Healthcare workers are also falling ill or needing to be quarantined, further depleting the workforce at this time of increased need. Despite the significant psychological burden, centres around the world celebrate the resilience of their staff and their determination to care for their patients as best as possible.

Globally, mitigation strategies in dialysis units include:

  • Temperature checking and health screening of staff and patients prior to entering units
  • Cohorting (spatially and temporally) patients with suspected and proven COVID-19
  • Maintaining social distancing within units, where possible
  • PPE for staff when dealing with COVID-19+ or suspected patients
  • Differing rules about the wearing of face masks for asymptomatic in-centre dialysis patients
  • Educating patients on signs of COVID-19, social isolation and handwashing
  • The use of telehealth in place of physical reviews

Major challenges reported include:

  • Vastly increased workload with decreased staffing capacity
  • Lack of test kits
  • Lack of widespread testing, especially in outpatient facilities
  • Initial false negatives with earlier test kits
  • Lack of PPE
  • Difficulties in transporting patients to and from dialysis when there is a lockdown
  • Increased demand on dialysis services mean some centres have decreased number of sessions or number of hours per session for chronic haemodialysis patients

General measures for prevention

The following are general measures advised by Center for Disease Control (CDC)[6]. and the National Institute for Communicable Disease (NICD) [7]. of South Africa to minimize exposure to COVID-19:

  1. Wash your hands often with soap and water for at least 20 seconds. (
  2. If soap and water are not available, use an alcohol-based (>60% alcohol) hand sanitizer.
  3. Avoid touching your eyes, nose, and mouth with unwashed hands.
  4. Avoid close contact with people who are sick.
  5. Stay at home when you are sick and try and keep your distance from others at home.
  6. Cough or sneeze into a tissue or a flexed elbow, then throw the tissue into the bin.
  7. Clean and disinfect frequently touched objects and surfaces.
  8. Avoid touching surfaces used in public places. You may want to use a hand towel or tissue if possible when touching doorknobs, light switches, etc.
  9. You may want to take your shoes off when you enter your house. Some people have outdoor shoes and indoor shoes or slippers.
  10. Avoid greeting people with a handshake, hug or a kiss. A smile and a verbal greeting will be just fine.
  11. If you are sick, stay home, except to get medical care. Or if someone else is sick, avoid visiting or being with the sick person.
  12. If you have traveled to another country where the coronavirus has been confirmed or you have been with someone who has a confirmed case of the coronavirus, inform your health authority as you may need to be quarantined for 14 days.
  13. If you have concerns about being exposed to the coronavirus, use your judgment—you may want to avoid attending large public events, or travel to countries with with large numbers of infections.
  14. Contact your doctor if you feel sick. The main symptoms of the Coronavirus are: fever, cough, and shortness of breath. Your doctor can order a test if the Coronavirus infection is suspected.
  15. Avoid contact with farm or wild animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).
  16. Wear a facemask if you are sick and are around other people or visiting a health facility or if you are caring for someone who is sick

General management

All the patients with confirmed COVID-19 should be quarantined. Not all patients need hospital admission. In view of rapidly increasing demand, countries are developing hospitalization policies, In general, high-risk patients, or those with severe infection need admission in isolation units in designated hospitals. Supportive care, namely bed rest, nutritional and fluid support, maintenance of blood pressure and oxygenation are important measures, as for all critically ill patients.