COVID-19 DIALYSIS PATIENTS

No. People who are on dialysis and who have also contracted COVID-19 are considered to be at high-risk. If there is availability, these patients may even be admitted to a hospital. In the event your symptoms are mild, you should be able to go to your dialysis center for your scheduled treatments.

The Centers for Disease Control has already issued interim guidance for patients on dialysis who have COVID-19 and all centers should be following these guidelines.

If you have a confirmed case of COVID-19, or have symptoms of COVID-19, or believe you may have been exposed to the coronavirus, then call your dialysis center prior to your scheduled appointment as there may be new procedures they would like you to follow.

How are dialysis centers protecting patients?

The Centers for Disease Control has issued interim guidance for patients on dialysis who have COVID-19 and all centers should be following these guidelines.

• Everyone, including all patients receiving treatment at the center, home dialysis patients, staff, and visitors who may have been exposed to the coronavirus, and people who currently have symptoms of COVID-19 should be asked if they:
  • have had any fevers or any breathing or respiratory (lung) symptoms
  • live in an area with confirmed COVID-19 cases
  • had contact with someone who is being checked for COVID-19, or if they have recently been in another country where COVID-19 has spread
• Centers should take patients’ temperatures at check-in.
• Have separate waiting areas for sick patients that are at least six feet from other patients (some centers allow healthy patients to wait outside or in their cars until it’s their turn to be seen)
• Patients with respiratory symptoms should be given wear masks to wear and they should be dialyzing six feet away in all directions from healthy patients. In some centers, patients with respiratory symptoms may be dialyzed in a separate area.
• Visitors with signs/symptoms of infection should not be permitted to enter the dialysis center
• Use cleaning procedures that kill the coronavirus, along with all routine cleaning and disinfection procedures.

If your dialysis center is not following these guidelines, you should call your local ESRD network. You can find your local ESRD network here.

National Coordinating Center (NCC) for ESRD Networks

What are dialysis centers doing to prevent COVID-19 from spreading?

Dialysis clinics are checking all patients who come into the clinic for signs and symptoms of COVID-19. They are keeping all patients who show any signs of illness at a safe distance from other patients. Sick patients wear masks from the time they enter the unit until after they leave the unit.

Clinics are also following strict methods of cleaning and disinfecting the entire treatment area, including machines and other surfaces. Go here for more details.

Is the re-use of masks at dialysis centers acceptable?

There have reports that dialysis providers are using masks in an abundance of caution, which may also lead to re-use of masks in times of shortage.

It is best for people receiving dialysis to discuss the issue of reusing masks with their dialysis provider.

There are CDC recommendations for the re-use of masks for areas experiencing severe shortages. Some of these recommendations include:

• Facemasks that fasten via ties may not be able to be undone without tearing and should not be re-used.
• Facemasks with elastic ear hooks may be more suitable for re-use.
• If these masks are to be re-used, the facemask should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.

These guidelines were drafted for healthcare professionals, but the Kidney Community Emergency Response (KCER) believes they also apply to patients.

What should I do before going to my dialysis center?

Can dialysis patients recover from COVID-19?

High-risk patients, such as those on dialysis, may be at higher risk for severe disease from COVID-19.

For severe cases, recovery may take 6 weeks or more. About 1% those infected will die from the disease.

Find more information about COVID-19 from John Hopkins.

• If you are experiencing any respiratory symptoms, you should call the center ahead of your visit to let them know.
• Pack hand sanitizer and use it frequently

What do I do if my home dialysis supplies are delivered and left outside?

Home dialysis supply companies are not bringing deliveries into the house due to COVID-19. Instead the entire delivery is being left outside. This is a problem especially if you have a peritoneal dialysis (PD) catheter and should not lift anything heavy.

In some cases, if dialysis staff speak to their local home dialysis supply representative, the company may be willing to put the supplies right inside your doorway, as long as you practice social distancing by going into another room of the house. If this is not an option, some dialysis centers may be able to send a patient technician to bring the supplies into your house. Call your dialysis staff for their suggestions on this matter.

How can I protect myself if I need a blood test or other labs?

” Keep in mind that you may need a new “order” from your doctor if you use a new lab.”

For routine blood draws or other kinds of labs, contact your healthcare provider to determine if the test can be postponed. If your doctor feels the test is necessary to do now, contact your lab to see if it can be done at home. Check if your lab is accepting urine samples dropped off at their site or sent through the mail. Sterile specimen cups can be purchased online or may be in stock at a local pharmacy.

If home testing is not an option, you should ask your lab, doctor, or transplant coordinator if there are any local labs that can provide in-home testing services. Not all health insurance plans cover lab visits at home, so you should contact your insurance provider to learn about your coverage.

Staying safe at the lab

If the test cannot be postponed or done in your home, you should know that medical facilities are taking precautions to keep you healthy. Hospitals, labs, doctors’ offices, and dialysis centers are evaluating patients and staff, such as checking temperatures and asking questions, to assess each person for active COVID-I9. If it is suspected that someone has the virus, then those people are kept isolated from all healthy people.

Prevention tips

It is also important that you take measures to help keep yourself safe and reduce the chance of getting COVID-19. Be sure to wear a mask when you go outside your home. Keep at least 6 feet distance between you and other people. Remember to wash your hands frequently and use hand sanitizer if there are no washing facilities. Avoid touching your eyes, mouth, and nose.

Be well prepared

Have extra supplies on hand, including surgical masks, hand sanitizer, and disposable gloves, so that if you come into contact with someone at a medical facility or if a technician comes to your home, you are both well protected. For in-home visits be sure to disinfect any surfaces that another person may have touched, such as doorknobs and countertops.

Should CKD patients wear masks in public?

It is best to stay home, unless you need to attend a dialysis treatment. If you must go out in public, ask your healthcare provider if it is necessary as a CKD patient to wear a face mask since each individual case is different.

The Center for Disease Control (CDC) recommends face masks for those who are infected with COVID-19, have symptoms of COVID-19, or taking care of someone with COVID-19.

The CDC also recommends wearing cloth face coverings to slow the spread of COVID-19 in areas where community-based transmission is significant. These homemade cloth face coverings are not masks and do not replace the President’s Coronavirus Guidelines.

Tips for using a mask include a snug but comfortable fit covering the bridge of the nose and the entire mouth. Also, be sure to be laundered the cloth mask after use each outdoor use, ideally without damage to the shape or structure of the mask. The CDC is recommending a cloth face cover like the t-shirt used in this video. The CDC also recommends coffee filters as an alternative. Use of any mask is in addition to practicing social distancing or at least 6 feet from others to limit coronavirus spread. All patients at high risk, such as immunosuppressed transplant recipients or people receiving dialysis should follow the directions of their clinicians regarding the type of face covering that should be used outside of a clinic setting.

When in public it is important to practice social distancing by staying 6 feet away from other people and to also avoid touching your face. Wash your hands immediately after you have been in public.

Should CKD patients wear masks in public?

It is best to stay home, unless you need to attend a dialysis treatment. If you must go out in public, ask your healthcare provider if it is necessary as a CKD patient to wear a face mask since each individual case is different.

The Center for Disease Control (CDC) recommends face masks for those who are infected with COVID-19, have symptoms of COVID-19, or taking care of someone with COVID-19.

The CDC also recommends wearing cloth face coverings to slow the spread of COVID-19 in areas where community-based transmission is significant. These homemade cloth face coverings are not masks and do not replace the President’s Coronavirus Guidelines.

Tips for using a mask include a snug but comfortable fit covering the bridge of the nose and the entire mouth. Also, be sure to be laundered the cloth mask after use each outdoor use, ideally without damage to the shape or structure of the mask. The CDC is recommending a cloth face cover like the t-shirt used in this video. The CDC also recommends coffee filters as an alternative. Use of any mask is in addition to practicing social distancing or at least 6 feet from others to limit coronavirus spread. All patients at high risk, such as immunosuppressed transplant recipients or people receiving dialysis should follow the directions of their clinicians regarding the type of face covering that should be used outside of a clinic setting.

When in public it is important to practice social distancing by staying 6 feet away from other people and to also avoid touching your face. Wash your hands immediately after you have been in public.

Ordering take-out with confidence

Many restaurants are now closed to enforce social distancing, but take-out is still available from many eateries. Here are some ideas for making ordering take-out easy even with your special kidney diet. Start by knowing your diet well and asking your dietitian for any tips or advice. If you have sodium, potassium, phosphorus, or protein restrictions, this information will help you make good decisions based on your specific dietary needs.

Plan ahead

Choose a restaurant where it will be easiest to select foods best suited for your diet. Restaurants where food is made to order are the best choice.

Making your selections

Look over the menu carefully. Ask for more details about items you do not know about. When you place your order explain that you are following a special diet. Make special requests about the way your food is prepared as follows:

Entrées:

• Portions served in restaurants may be much larger than what you eat at home. When ordering take-out, estimate an amount close to what you normally have. (3 ounces of cooked meat, fish, or poultry is about the size of a deck of cards). Plan to have leftovers or split the meal with another person.
• Grilled items are good choices.
• Request that salt not be added when cooking.
• Request that gravies or sauces be served in a separate container.
• Avoid mixed dishes or casseroles. They are usually higher in sodium and phosphorus.
• Remove the skin from poultry and any crusts from fried foods to decrease sodium content.
• It is best NOT to add steak sauce, Worcestershire sauce, soy sauce, or hot sauce because of the high sodium content.
• Lemon or lime juice and vinegar make good sauces and will bring out a lot of the natural flavor of foods. Black pepper will add zest to the food without making you thirsty.

Side dishes:

• If you need to restrict potassium, choose starches and vegetables that are lower in potassium, such as rice, noodles and green beans.
• If your meal does not include a good choice for your diet, request a substitute.
• Ask that sauces be omitted or served in a separate container.

Stay safe

Ask the delivery person to leave the bag outside your door or be sure to keep your distance from them, especially if you need to pay them directly. If you have to pay them directly, consider wearing gloves. You can also wipe down the bag with a disinfectant wipe. Make sure food is well heated and reconsider the use of uncooked foods that aren’t prepackaged. Of course, wash your hands before eating. Other tips on Safe Food Handling can be found at the FDA website.

What foods should I have on hand?

Dialysis friendly foods are low potassium, low phosphorous, low sodium

Fruits, 1/2 cup = 1 serving (limit to 2-3 servings/day)

• Canned or sealed container, no sugar added: (drained and rinsed)
  • Applesauce
  • Apricots
  • Fruit Cocktail
  • Peaches
  • Pears
  • Pineapples
  • Mandarin Oranges
• Juice
  • Cranberry
  • Apple
  • Grape
  • Pineapple
• Fruit punch
• Lemonade
• Limeade

Vegetables, 1/2 cup = 1 serving (limit to 2-3 servings/day)

• Canned or sealed container, low-sodium or no salt added (drained and rinsed)
  • Bamboo Shoots
  • Beets
  • Carrots
  • Corn
  • Green Beans
  • Mushrooms
  • Pumpkin
  • Sweet Peas
  • Water Chestnuts

Protein

• Canned or sealed container, low-sodium: (drained and rinsed)
  • Tuna
  • Salmon
  • Meat
  • Turkey
  • Chicken
• Shelf stable Tofu
• Dried or no sodium added/low-sodium canned pinto or fava beans (1/4 cup) (drained and rinsed)
• Unsalted Nut Butter

Dairy (1/2 cup/day)

• Dry Milk Solids
• Evaporated milk
• Shelf stable milk alternative (refrigeration required after opened)
  • Rice, soy, almond

Grain

• Bread
  • White
  • Light Rye
  • Sourdough
• Dry Cereal: unsalted, puffed wheat or rice. Avoid bran and high fiber. Good choices include, but are not limited to:
  • Cornflakes
  • Honey Bunches of Oats
  • Life Cereal
  • Puffed Rice
  • Rice Krispies
  • Special K Oats & Honey
• Cooked Cereal
  • Cream of rice or wheat
  • Grits
• White Pasta
• White or brown rice
• Unsalted crackers

Fats

• Unsalted butter or margarine
• Low-sodium mayonnaise (single packets)
• Vegetable oil
  • Olive oil
  • Canola oil

Sweets

• Animal crackers
• Chewing gum
• Graham crackers
• Hard candy
• Jellybeans
• Vanilla Wafers

Other

• Honey
• Jelly
• Jam

What kind of foods should I have in my house?

If there is a virus outbreak in your area and you need to decrease your risk of getting sick, it’s important that you have food in your home. This will help reduce your risk of infection by allowing you to avoid crowded spaces like grocery stores and drug stores.

It’s important for you to have shelf stable food choices to help you follow your kidney diet. Shelf stable means foods that last a long time without spoiling, such as canned foods. It’s important to prepare now by stocking up 2-3 weeks’ worth of healthy, kidney friendly foods, fresh water, and medicines. Check with your healthcare professional if you have any questions about your medications.

What are some kidney friendly low-sodium items (no potassium or phosphorus restriction)?

Includes all dialysis friendly foods as well as foods listed below.

Fruits (2-3 servings/day)

• No sugar added canned fruits
• Dried fruit
• Fruit Juice

Vegetables (2-3 servings/day)

• No salt added or low-sodium canned vegetables

Protein

• Low-Sodium canned meat
• Tuna
• Salmon
• Meat
• Turkey
• Chicken
• Dried beans and peas
• No sodium added or low-sodium canned beans
• Shelf stable Tofu
• Unsalted Nut butter
• Unsalted Nuts and Seeds

Dairy (2-3 cups/day)

• Dry Milk Solids
• Evaporated milk
• Shelf stable milk alternative (refrigeration required after opened)
• Rice, soy, almond

Grain

• Whole grain breads and pastas
• White or brown rice
• Unsalted crackers
• Dry cereals: Low sodium
• Cooked Cereals
• Cream of wheat or rice
• Grits
• Rolled or steel cut oats

Fats

• Unsalted butter or margarine
• Low-sodium mayonnaise (single packets)
• Salad or cooking oil

Sweets

• Animal crackers
• Chewing gum
• Graham crackers
• Hard candy
• Jellybeans
• Vanilla Wafers

Other

• Low-sodium Soups and Broths
• Honey
• Jelly
• Jam

Can COVID-19 cause kidney failure in otherwise healthy adults?

There have been recent reports of nonelderly adults infected with COVID-19 who have developed an acute kidney injury (AKI) — sudden loss of kidney function. These adults did not have underlying medical conditions. With proper treatment, including dialysis in severe cases, AKI can be reversible.

Acute kidney injury (AKI) and chronic kidney disease (CKD)

Acute kidney injury (AKI) is not the same as chronic kidney disease (CKD), which will eventually lead to chronic kidney failure (CKF). Neither CKD or CKF are reversible diseases. Detecting proteins and/or blood in urine labs is an early sign of kidney involvement in people with confirmed COVID-19.

AKI and COVID-19

Initial reports from Wuhan found approximately 3% to 9% of hospitalized patients with confirmed COVID-19 developed an AKI. Incidence rates have now increased to 15% of hospitalized patients and 20% and higher in ICU patients with many requiring dialysis treatments. AKI appears to be a marker of COVID-19 infection severity and the mortality rate is higher for these patients

Various COVID-19-related effects that are thought to contribute to AKI include kidney tubular injury (acute tubular necrosis) with septic shock, microinflammation, increased blood clotting, and probable direct infection of the kidney. Most patients with COVID-19-related AKI who recover continue to have low kidney function after discharge from the hospital.

Long term implications of AKI

It’s recommended that recovered COVID-19 patients who had an AKI should be seen regularly by a kidney doctor, because their risk of developing chronic kidney disease is higher than others. COVID-19 patients who did not develop an AKI, but who had blood and/or protein in their urine, should be monitored since they are at increased risk of developing chronic- and end-stage-kidney disease.

Feeling stress and depression?

“It’s common for people who have been diagnosed with chronic kidney disease, patients on dialysis, and those who have received kidney transplants to feel sad and depressed. In fact, studies show that 20% to 40% of people with kidney failure may also have depression. While the risk of severe illness due to COVID-19 remains low in the general population, people who have a chronic illness or who are taking immunosuppressant drugs are at an increased risk of becoming very ill. These fears are real – and the worry and stress can lead to an even greater bout of depression. If you are feeling more depressed than usual, The Centers for Disease Control has some great tips for helping you to manage your stress and anxiety.

Coping strategies

If you are feeling more depressed than usual, The Centers for Disease Control has some great tips for helping you to manage your stress and anxiety.

It is true — the coming days are going to be unlike any we’ve ever had to face before – however, there are ways to help manage stress and depression and to help you cope when you feel sad and overwhelmed.

For more information

• 5 Ways to Cope
• Dialysis Depression – Patients Helping Patients
• Depression and kidney disease
• Injecting hope back into the world
• Stress and Your Kidneys

What does “shelter in place” mean?

Shelter in place means to stay at home. Exceptions to go out may include tasks that are essential to the health and safety of your family and pets.

If you are at higher risk for serious illness from COVID-19 because of your age or other serious health problems such as kidney disease, you should not go out except for essential medical appointments and treatments such as dialysis.

Additionally, non-essential businesses are closed such as dine-in restaurants, bars and nightclubs, entertainment venues, fitness centers, hair salons, public events, and convention centers. The purpose is to avoid large groups of people from gathering to prevent spread of COVID-19.

Businesses that may be open include stores that sell groceries, take-out and delivery restaurants, gas stations, pharmacies, laundromats, banks, and government offices and services. Check on local information for shelter in place rules in your area.

What does “lock-down” mean?

In the context of COVID-19, “lock-down” and “shelter in place” (see above) are being used interchangeably. Check on local information for lock-down rules in your area.

When should I leave my home?

The best practice is to stay at home except for essential medical appointments and treatments, such as dialysis. You may also have to leave your home for other health-related issues. If you have symptoms of COVID-19, call your healthcare provider immediately. If you have a medical emergency call 911.

In some areas, supermarkets are offering special shopping hours for senior citizens to shop without additional crowds in the store. This may be a good option for older adults if grocery delivery is not available. Check on local information about when to leave your home.

Should I use public transportation?

Public transportation such as buses, subways, and trains will increase your chances of close contact with more people which may increase your exposure to COVID-19. In some areas, public transportation is reserved for essential workers. You may choose to use a taxi or ride share service to limit your exposure to large numbers of people.

How can I protect myself if I have to use a taxi or ride share?

You can protect yourself in a taxi or ride share by wiping down the seat, seat belt and anything else you may touch in the vehicle with a disinfectant wipe. Don’t shake hands with anyone in the vehicle and don’t touch your face. Wash your hands or use hand sanitizer after paying for the ride.

How can I help prevent my loved one from getting COVID-19?

Older people and those with underlying medical conditions, such as chronic kidney failure or people have had a kidney transplant and take immunosuppressive drugs, are at increased risk of contracting COVID-19 and developing serious complications.

Learn more about how to protect yourself from COVID-19 on the Centers for Disease Control (CDC).

What should I know about shelf stable foods?

It’s important to keep shelf stable foods on hand to avoid getting sick if an outbreak happens in your area.

Reminders:

• Throw away cans that are opened, dented, or past their expiration date to avoid food poisoning.
• Avoid using salt (and salt substitutes if you have a potassium restriction)
• Keep distilled water on hand (bottles or jugs).

What about other underlying medical conditions?

There are other underlying medical conditions that people may have in addition to having undergone a kidney transplant recipient or dialysis treatment.

Some of these conditions are:

• Chronic lung disease or moderate-to-severe asthma
• Serious heart conditions
• Immunocompromised due to cancer treatment, smoking, bone marrow transplantation, immune deficiencies, HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
• Severe obesity (body mass index [BMI] of 40 or higher)
• Diabetes
• Liver disease