Ido Zamberg1, Thomas Mavrakanas2,3, Thomas Ernandez3,4, Vincent Bourquin4,5, Michael Zellweger5, Nicolas Marangon6, Françoise Raimbault3, Rebecca Winzeler7, Anne Iten8, Nathalie Hammer9, Belen Ponte3, Sebastian Carballo9, Pierre-Yves Martin3, Patrick Saudan3. 1. Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. 2. Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada. 3. Division of Nephrology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 4. Dialysis Unit, Hôpital de la Tour, Meyrin, Switzerland. 5. Dialysis Unit, Groupe médical d'Onex, Switzerland. 6. Dialysis Unit, MV Santé, Geneva, Switzerland. 7. Swiss Dialysis Registry, Institute of Nephrology, Stadtspital Waid and Triemli, Zurich, Switzerland. 8. Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland. 9. Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Abstract
BACKGROUND: Patients on maintenance dialysis are at high risk for serious complications from COVID-19 infection, including death. We present an overview of local experience with dialysis unit management and reorganisation, local epidemiology and outcomes during the COVID-19 outbreak in Geneva, Switzerland, where SARS-CoV-2 incidence was one of the highest in Europe. METHODS: All SARS-CoV-2-positive outpatients on maintenance dialysis were transferred from their usual dialysis facility to the Geneva University Hospitals dialysis unit to avoid creation of new clusters of transmission. Within this unit, appropriate mitigation measures were enforced, as suggested by the institutional team for prevention and control of infectious diseases. RESULTS: From 25 February to 31 December 2020, 82 of 279 patients on maintenance dialysis tested positive for SARS-CoV-2 during two distinct waves, with an incidence rate of 73 cases per 100,000 person-days during the first wave and 342 cases per 100,000 during the second wave, approximately four- to six-fold higher than the general population. The majority of infections (55%) during both waves were traced to clusters. Most infections (62%) occurred in men. Sixteen patients (34%) died from COVID-19 related complications. Deceased patients were older and had a lower body mass index as compared with patients who survived the infection. CONCLUSION: SARS-CoV-2 is associated with high infection and fatality rates in the dialysis population. Strict mitigation measures seemed to be effective in controlling infection spread among patients on maintenance dialysis outside of clusters. Large scale epidemiological studies are needed to assess the efficacy of preventive measures in decreasing infection and mortality rates within the dialysis population.
BACKGROUND: Patients on maintenance dialysis are at high risk for serious complications from COVID-19 infection, including death. We present an overview of local experience with dialysis unit management and reorganisation, local epidemiology and outcomes during the COVID-19 outbreak in Geneva, Switzerland, where SARS-CoV-2 incidence was one of the highest in Europe. METHODS: All SARS-CoV-2-positive outpatients on maintenance dialysis were transferred from their usual dialysis facility to the Geneva University Hospitals dialysis unit to avoid creation of new clusters of transmission. Within this unit, appropriate mitigation measures were enforced, as suggested by the institutional team for prevention and control of infectious diseases. RESULTS: From 25 February to 31 December 2020, 82 of 279 patients on maintenance dialysis tested positive for SARS-CoV-2 during two distinct waves, with an incidence rate of 73 cases per 100,000 person-days during the first wave and 342 cases per 100,000 during the second wave, approximately four- to six-fold higher than the general population. The majority of infections (55%) during both waves were traced to clusters. Most infections (62%) occurred in men. Sixteen patients (34%) died from COVID-19 related complications. Deceased patients were older and had a lower body mass index as compared with patients who survived the infection. CONCLUSION: SARS-CoV-2 is associated with high infection and fatality rates in the dialysis population. Strict mitigation measures seemed to be effective in controlling infection spread among patients on maintenance dialysis outside of clusters. Large scale epidemiological studies are needed to assess the efficacy of preventive measures in decreasing infection and mortality rates within the dialysis population.
Authors: Markus Joerger; Yannis Metaxas; Khalil Zaman; Olivier Michielin; Nicolas Mach; Adrienne Bettini; Andreas M Schmitt; Nathan Cantoni; Clemens B Caspar; Sonja Stettler; Roma Malval; Miklos Pless; Christian Britschgi; Christoph Renner; Dieter Koeberle; Jessica D Schulz; Christoph Kopp; Stefanie Hayoz; Anastasios Stathis; Roger von Moos Journal: Cancers (Basel) Date: 2022-04-27 Impact factor: 6.575