Dialysis should not occur in an outpatient facility for a person under investigation for the novel coronavirus, also known as COVID-19, unless an airborne isolation room is available, according to new guidance from the American Society of Nephrology.
“Currently [a person under investigation] or individuals with confirmed COVID-19 should not receive dialysis in an outpatient dialysis facility due to the inability to perform dialysis in an [airborne isolation room] AIIR,” according to an ASN document. “Therefore, if unable to perform home dialysis, these individuals will need to undergo dialysis in an acute care hospital in an AIIR.”
Guidance was also distributed by the American Society of Transplantation, with a focus on the known risks of the immunocompromised patient.
“Infection still needs to be acquired from someone who is shedding virus. It is not proven but appears that asymptomatic transmission can occur,” the AST wrote on its website. “The incubation is 2 [to] 14 days in the general population; however, the inoculum size required to infect a transplant patient may be lower. Based on data from influenza and SARS, if infection occurs, progression to pneumonia will likely be more common in the immunocompromised population, including transplant recipients. In addition, a greater viral burden and shedding will likely result in greater infectivity.”
The AST also offered guidance on whether living or deceased donors should be screened, noting, “A travel history for the deceased donor is essential and should consider travel to China, Iran, Italy, South Korea, or anywhere local transmission is occurring. History of contact with a known case of COVID-19 should also be elicited. A deceased donor with known or highly suspected COVID-19 infection should be deferred for all organs to avoid transmission to recipient as well as to the health care team. There are reports of coronavirus RNA being isolated outside the lungs including in stool and blood in some cases and therefore it is possible extra-pulmonary infection can occur. Case-by case consideration is required for deceased donors with epidemiologic risks and within the 14-day incubation period, but otherwise asymptomatic for those that were previously infected with COVID-19 but have recovered. Each case should consider the urgency of transplant and the potential risk to the recipients, as well as consider isolation interventions if organs are used.”
Living donors who traveled to a high-risk area within the last 2 weeks prior to donation should be deferred until 14 days from travel.
“Potential living donors can be advised to not travel to areas where local transmission is occurring and to report new onset cough and flu-like symptoms,” according to the AST. “Routine testing of living and deceased donors for COVID-19 is not suggested at this time. This may evolve over time as the outbreak situation evolves.”
The CDC has reported 80 cases in the United States that include “presumptive positives or CDC-confirmed positive cases” of COVID-19 from 13 states. Nine deaths attributed to COVID-19 have now been reported.
On February 27, the CDC updated the COVID-19 person under investigation definition to include a person with fever with severe acute lower respiratory illness (eg, pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (eg, influenza).
Editor's Note: This was the most current information as of March 4, but it is an evolving situation and guidelines change. Healio is working to provide the latest information to health care providers. Visit our COVID-19 Resource Center for more.