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