Worldwide Early Impact of COVID-19 on Dialysis Patients and Staff and Lessons Learned: A DOPPS Roundtable Discussion

Abstract

As the worst global pandemic of the past century, coronavirus disease 2019 (COVID-19) has had a disproportionate effect on maintenance dialysis patients and their health care providers. At a virtual roundtable on June 12, 2020, Dialysis Outcomes and Practice Patterns Study (DOPPS) investigators from 15 countries in Asia, Europe, and the Americas described and compared the effects of COVID-19 on dialysis care, with recent updates added. Most striking is the huge difference in risk to dialysis patients and staff across the world. Per-population cases and deaths among dialysis patients vary more than 100-fold across participating countries, mirroring burden in the general population. International data indicate that the case-fatality ratio remains at 10% to 30% among dialysis patients, confirming the gravity of infection, and that cases are much more common among in-center than home dialysis patients. This latter finding merits urgent study because in-center patients often have greater community exposure, and in-center transmission may be uncommon under optimal protocols. Greater telemedicine use is a welcome change here to stay, and our community needs to improve emergency planning and protect dialysis staff from the next pandemic. Finally, the pandemic's challenges have prompted widespread partnering and innovation in kidney care and research that must be sustained after this global health crisis.

Keywords: COVID-19; DOPPS; dialysis; international; risk.

Figure 1

Coronavirus disease 2019 (COVID-19) cases and deaths in general population, by participating country. Peak cases per day, per 100,000 population for (A) January to August 2020 and (B) September 2020 to January 2021. (C) Cumulative cases, per 100,000 population (as of January 31, 2021). (D) Cumulative deaths, per 100,000 population (as of January 31, 2021). Abbreviations: BE, Belgium (A: April 15, 2020; B: October 29, 2020); BR, Brazil (A: July 29, 2020; B: January 7, 2021); CA, Canada (A: April 5, 2020; B: January 3, 2021); CN, China (A: February 13, 2020; B: January 21, 2021); DE, Germany (A: March 27, 2020; B: December 30, 2020); ES, Spain (A: August 31, 2020; B: January 25, 2021); FR, France (A: April 12, 2020; B: November 2, 2020); IT, Italy (A: March 21, 2020; B: November 13, 2020); JP, Japan (A: July 30, 2020; B: January 8, 2021); KR, South Korea (A: March 3, 2020; B: December 24, 2020); SA, Saudi Arabia (A: June 17, 2020; B: September 1, 2020); SE, Sweden (A: June 14, 2020; B: December 29, 2020); TH, Thailand (A: March 22, 2020; B: January 29, 2021); UK, United Kingdom (A: April 2, 2020; B: January 8, 2021); US, United States (A: July 16, 2020; B: January 2, 2021). Source: Our World in Data.

Figure 1

Coronavirus disease 2019 (COVID-19) cases and deaths in general population, by participating country. Peak cases per day, per 100,000 population for (A) January to August 2020 and (B) September 2020 to January 2021. (C) Cumulative cases, per 100,000 population (as of January 31, 2021). (D) Cumulative deaths, per 100,000 population (as of January 31, 2021). Abbreviations: BE, Belgium (A: April 15, 2020; B: October 29, 2020); BR, Brazil (A: July 29, 2020; B: January 7, 2021); CA, Canada (A: April 5, 2020; B: January 3, 2021); CN, China (A: February 13, 2020; B: January 21, 2021); DE, Germany (A: March 27, 2020; B: December 30, 2020); ES, Spain (A: August 31, 2020; B: January 25, 2021); FR, France (A: April 12, 2020; B: November 2, 2020); IT, Italy (A: March 21, 2020; B: November 13, 2020); JP, Japan (A: July 30, 2020; B: January 8, 2021); KR, South Korea (A: March 3, 2020; B: December 24, 2020); SA, Saudi Arabia (A: June 17, 2020; B: September 1, 2020); SE, Sweden (A: June 14, 2020; B: December 29, 2020); TH, Thailand (A: March 22, 2020; B: January 29, 2021); UK, United Kingdom (A: April 2, 2020; B: January 8, 2021); US, United States (A: July 16, 2020; B: January 2, 2021). Source: Our World in Data.

Figure 2

Proportion of coronavirus disease 2019 (COVID-19) cases among kidney replacement therapy (KRT) patients, by modality. Most recent data as of: (A) August 31, 2020, and (B) January 31, 2021. Data are from Table 1. Red bar indicates in-center hemodialysis (HD) except (∗) all dialysis for France (FR) and (∗∗) all KRT for United States (US). Abbreviations: BE, Belgium; BR, Brazil; CA, Canada; DE, Germany; ES, Spain; IT, Italy; JP, Japan; KR, South Korea; SA, Saudi Arabia; TH, Thailand; UK, United Kingdom.

Figure 3

Cumulative coronavirus disease 2019 (COVID-19) (A) cases and (B) deaths (as percent of all dialysis patients) by cumulative deaths per 100,000 in general population. Dialysis data are shown for in-center hemodialysis (HD) patients except for France (FR; all dialysis patients) and United States (US; all kidney replacement therapy patients). Population data are as of date of dialysis data. Abbreviations: BE, Belgium (1: May 2020); BR, Brazil (1: July 2020); CA, Canada (1: July 2020); DE, Germany (1: July 2020); ES, Spain (1: July 2020; 2: January 2021); FR (1: July 2020; 2: December 2020); IT: Italy (1: April 2020); JP, Japan (1: August 2020; 2: December 2020); KR: South Korea (1: July 2020; 2: January 2021); SA, Saudi Arabia (1: July 2020; 2: December 2020); TH, Thailand (1: June 2020); UK, United Kingdom (1: June 2020; 2: December 2020); US (1: July 2020; 2: November 2020). Source: Table 1 (dialysis data) and Our World in Data (population data).

Figure 4

Examples of information sharing, partnering, and innovation during the coronavirus disease 2019 (COVID-19) pandemic that we can learn from to accelerate transformation after the pandemic ends. Abbreviations: CSN, Canadian Society of Nephrology; NICE, National Institute for Health and Care Excellence; RRT, renal replacement therapy.