COVID-19: Issues related to kidney disease and hypertension


COVID-19: Issues related to kidney disease and hypertension

This topic will discuss issues related to COVID-19 and delivery of nephrology care in patients with end-stage kidney disease (ESKD), acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension. Issues related to the care of patients who are candidates for or have a kidney transplant are discussed separately.


Patients with end-stage kidney disease (ESKD) are particularly vulnerable to severe COVID-19 due to the older age and high frequency of comorbidity, such as diabetes and hypertension, in this population. Management of patients with ESKD varies based upon whether they are hospitalized or are in the outpatient setting.

Outpatients with ESKD - A majority of patients with ESKD are treated with some form of dialysis. These include in-center hemodialysis, home hemodialysis, or peritoneal dialysis.

  • Early recognition/isolation of individuals with respiratory symptoms — Outpatient dialysis facilities should, at minimum, heed the following guidance.
  • Implement non-punitive and flexible sick leave policies that permit ill health care personnel to stay home. Health care personnel should be reminded to not report to work when they are ill.
  • Identify patients with signs and symptoms of respiratory infection (eg: fever, cough) before they enter the treatment area.
  • Instruct patients to call ahead to report fever or respiratory symptoms so the facility can be prepared for their arrival or triage them to a more appropriate setting (eg: an acute care hospital).
  • Patients should inform staff of fever or respiratory symptoms immediately upon arrival at the facility (eg: when they check in at the registration desk).
  • Patients with symptoms of a respiratory infection should put on a facemask at check-in and should wear it until they leave the facility.
  • Provide patients and health care personnel with instructions (in appropriate languages) regarding hand hygiene, respiratory hygiene, and cough etiquette.
  • Instructions should include how to use facemasks, how to use tissues to cover the nose and mouth when coughing or sneezing, how to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
  • Signs should be posted at clinic entrances with instructions for patients to alert staff so appropriate precautions can be implemented for patients who have a fever or symptoms of a respiratory infection.
  • Position hygiene-related supplies in close proximity to dialysis chairs and nursing stations to enable adherence to hand and respiratory hygiene. These supplies include tissues and no-touch receptacles for disposal of tissues as well as hand hygiene supplies (eg: alcohol-based hand sanitizer).
  • Patient placement - Outpatient dialysis facilities should, at minimum, heed the following guidance:
  • Provide sufficient space in waiting areas for patients to sit separated from other patients by at least six feet. Medically stable patients might opt to wait in a personal vehicle or outside.

Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.

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Journal of Nephrology and Urology
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