Coronavirus (Covid-19) and kidney diseases
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19) is the new viral pandemic that emerged from china and is now spreading rapidly across the world including India as well.
The Frequently reported signs and symptoms of patients admitted to the hospital include fever, cough, myalgia or fatigue, and shortness of breath at illness onset.
What’s unique about this virus, is that it has a long incubation period ranging from 2-14 days or even longer upto 21 to 28 days, an asymptomatic carrier phase, i.e one may start shedding the virus before showing signs and symptoms of the disease. The more unique about this virus is that it spreads not only through droplets/ aerosols but also through fomites which are inanimate objects like door handles and surfaces. These may harbour the virus upto two weeks of contact with infected surfaces followed by touching of nose, mouth or eyes through the same hands which can lead to entry of virus into the body.
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Patients who have no underlying medical conditions had an overall very low mortality rates approximately 0.9%, but mortality is higher for patients with other comorbidities like, uncontrolled diabetes, Hypertension, cardiovascular disease, chronic respiratory disease, Kidney failure( dialysis & transplant patients) and patients suffering from cancer.
This virus like any other serious infection can lead to multiorgan dysfunction and acute kidney injury, and in such patients overall mortality is much higher upto 27 to 29 % than otherwise.
There are various factors which makes kidney patients much more vulnerable for this infection:
- Presence of multiple underlying medical conditions.
- Overall low baseline/ innate immunity as Chronic kidney disease being immunosuppressed state.
- Need for frequent visits to hospital for dialysis or optimisation of medications.
- Delayed presentation of symptoms like fever etc. which might lead to delayed diagnosis and need high index of suspicion.
- Sometimes presenting to emergency with overlapping symptoms of respiratory distress/ fluid overload.
- Transplant patients being at higher risk of infection due to regular intake of immunosuppressants/ Transplant medication.
Corona virus spreads mainly from person to person. There are certain special precautions which kidney patients need to take. However, it’s important that everyone including kidney patients follow preventative measures recommended by the Centers for Disease Control (CDC) & ICMR as well as directives given by Government of India:
For all Kidney patients:
- Stay home if you feel sick or have any flu like symptoms such as fever, cough, sore throat, body aches, headache, chills and contact your doctor telephonically, follow their advise and visit hospital accordingly.
- Wear a facemask if you are having symptoms, and isolate yourself from other family members.
- Avoid others also who are sick. Limiting face-to-face contact with others as much as possible.
- Cover coughs and sneezes with a tissue, and then throw it in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
- Wash hands often with soap and water for at least 20 seconds; especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
- If you don’t have soap and water, use hand sanitizer with 60%-95% alcohol.
- Clean very often the things that get touched a lot, like door handles.
- Avoid touching your face, especially your nose and mouth.
- Continue taking all your medications regularly.
- Control blood pressure, stick to fluid and salt restriction.
- Avoid intake of unnecessary / prophylactic medications based on assumptions only and without consultation of your treating physician.
For dialysis patients:
- DO NOT miss your dialysis treatments. Contact your clinic if you feel sick or have any concerns before reaching dialysis unit.
- Always wear face mask in Hospital.
- Maintain social distancing in waiting area and inside dialysis unit.
- Sanitise your hands before starting dialysis.
- Avoid eating during dialysis.
For Transplant patients:
- Avoid frequent visits to hospital until unless advised by treating doctor.
- Continue regular medication intake. Arrange Transplant medications pre-emptively in view of extended lock down situation.
For Patients waiting for transplant:
Transplant should be withheld for few weeks. As-
- Introduction of Immunosupression / Transplant medications lowers the immunity further and can make these patients prone for infection.
- Surgery itself is a state of stress for human body and can increase chances of contracting infection.
- Prolonged hospital stay during perioperative period, frequent hospital visits for regular follow up and optimisation of medivations increases risk of infection.
Patients waiting for transplant should continue their dialysis on regular basis.
The important aspect is that one should not panic, taking proper precautions and avoidance of people with signs of respiratory tract infections and keeping the chronic diseases like diabetes and hypertension under control could help one tide over this crisis.
Dr Anuja Porwal
Department of Nephrology & Kidney Transplant
Fortis Hospital Noida