Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients

Abstract

Background and objectives: Patients receiving in-center hemodialysis treatment face unique challenges during the coronavirus disease 2019 (COVID-19) pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined.

Design, setting, participants, & measurements: We explored the role of variables, including community disease burden, dialysis unit attributes (size and layout), and infection control strategies, on rates of COVID-19 among patients receiving in-center hemodialysis in London, United Kingdom, between March 2, 2020 and May 31, 2020. The two outcomes were defined as (1) a positive test for infection or admission with suspected COVID-19 and (2) admission to the hospital with suspected infection. Associations were examined using a discrete time multilevel time-to-event analysis.

Results: Data on 5755 patients dialyzing in 51 units were analyzed; 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between March 2 and May 31, 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates, and dialysis unit size. A greater number of available side rooms and the introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices, nor with any of the different isolation strategies.

Conclusions: Rates of COVID-19 in the in-center hemodialysis population relate to individual factors, underlying community transmission, unit size, and layout.

Keywords: COVID-19; hemodialysis; infection control.

Graphical abstract

Figure 1.

Isolation and deisolation strategies for management of patients with clinically suspected or confirmed coronavirus disease 2019 (COVID-19). NP, nasopharyngeal; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Figure 2.

Epidemic timeline in patients on in-center hemodialysis across London. Patient cases (first of positive test or admission) by renal center expressed as actual numbers per day. Cases in the general population are available weekly by location and calculated by postcode per 10,000 population. The whole population average (dashed line) is weighted by the number of patients per postcode.

Figure 3.

Geographic distribution of cases by dialysis unit by week for the first 8 weeks of the pandemic and at the final follow-up week. Each in-center hemodialysis unit is represented by a circle. Circle size indicates the number of patients dialyzed. Circle color indicates the cumulative proportion of patients who tested positive for COVID-19 or were admitted with suspected COVID-19. Underlying green intensity reflects the number of cases in each middle layer super output area (not necessarily reflective of patients’ home locality as most, but not all, patients dialyze in their closest unit). Three units are not represented as they fall outside of the area of the map. Dates represent the first day of the week represented. MSOA, middle layer super output area.