COVID-19 Curbside Consults

Management of COVID-19 in special populations with kidney disease

Yeshwanter Radhakrishnan, MD, Mohamed Hassanein, MD and Brian Stephany, MD
Cleveland Clinic Journal of Medicine December 2020, DOI: https://doi.org/10.3949/ccjm.87a.ccc067

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Tables

  • TABLE 1

    Summary of recommendations for COVID-19 in special patient populations with kidney disease

    For all patients:

    • Social distancing and hand hygiene to reduce exposure to COVID-19

    • Use of PPE as recommended by the CDC

    • Education of health care workers and patients on advances in COVID-19


    In addition to above, for specific populations with
    Chronic kidney disease (CKD):

    • Virtual visits via telemedicine when in-person visits are not necessary

    • Continue RAS inhibitors in patients with stable CKD

    • Avoid remdesivir in patients with GFR < 30 mL/min per m2 unless benefits outweigh risks

    End-stage kidney disease on home-based dialysis:

    • Patients on peritoneal dialysis (PD): Maintain at least 2 weeks of PD supplies, remote management platforms to monitor PD sessions

    • Patients on home hemodialysis: Real-time monitoring of vital signs and treatment data

    • Home visits by healthcare workers should be avoided except for patients with disabilities or in cases of an emergency

    End-stage kidney disease on in-center hemodialysis:

    • Screening for COVID-19 symptoms and temperature checks for patients and staff depending on institution policy

    • Use of dedicated HD units for patients with COVID-19

    • Daily disinfection of dialysis equipment and supplies

    Kidney transplant recipients (KTRs):

    • Screening of donors and recipients prior to kidney transplant surgery

    • Ambulatory KTRs with COVID-19: continue home immunosuppression regimen

    • Inpatient KTRs:

      • Mild COVID-19 with no supplemental oxygen use: reduce MMF while maintaining CNI and steroid therapy

      • Severe COVID-19 requiring supplemental oxygen, dexamethasone, or remdesivir: Discontinue MMF, target lower CNI trough levels

    • CDC = Centers for Disease Control and Prevention; CNI = calcineurin inhibitor; GFR = glomerular filtration rate; MMF = mycophenolate mofetil; PPE = personal protective equipment; RAS = renin-angiotensin system

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