De-isolation of COVID-19–positive hemodialysis patients in the outpatient setting: a single-center experience

To the editor:

The advice for patients presenting with coronavirus disease 2019 (COVID-19) symptoms is to self-isolate for 7 days after the onset of symptoms for the individual case and 14 days for the household.¹ Dialysis patients can be considered as immunocompromised and display a decreased ability to develop seroconversion to infectious diseases.² Therefore, 7 to 14 days may not be an appropriate threshold in a dialysis population. In our center, we provide dialysis in 2 hospital-based and 6 satellite units, for a total of 664 patients (see Supplementary Methods). We isolated our COVID-19–positive dialysis outpatients in a dedicated unit and followed a pathway for de-escalation of stable patients with serial COVID-19 swabs, starting 7 days after confirmed diagnosis (Figure 1 , Supplementary Table S1). Thirty-four COVID-19–positive patients who had at least 3 swabs were included: 20 patients were de-isolated in less than 14 days (59%) with 9% on day 9. By day 12, 35% of patients could be dialyzed in their base unit (which is crucial for capacity). However, by day 15, 14 patients (41%) had not cleared the virus and could not be repatriated: 5 patients cleared the virus later (median of 18 days [range, 16–21]) and 9 patients were still positive or had only one negative swab at the end of follow-up. It is unclear whether detection of viral RNA represents the ability to transmit the virus,^{3 , 4} but until more evidence is available, it would be prudent to isolate patients as discussed to prevent cross-contamination in this high-risk population.

Figure 1.

De-escalation plan for coronavirus disease 2019 (COVID-19)–positive dialysis patients. HD, hemodialysis.

Disclosure

SG reports personal fees from Astellas, Enterobiotix, Menarini, MSD, Pfizer, and Shionogi, outside of the submitted work. All the other authors declared no competing interests.