COVID-19's impact on people who live with kidney disease

“In the context of the global and local spread of the coronavirus disease 2019 (COVID-19), we are concerned about all those who are at high-risk of developing a severe and possibly fatal respiratory illness due to the COVID-19 virus. This includes those over 65, those adults and children who live with chronic illness or who are immunocompromised for any reason,” says specialist paediatric nephrologist, Prof Errol Gottlich. Under his care are many children with kidney disease. Prof Gottlich is also Clinical Manager of Discovery Health’s KidneyCare programme, which is designed to optimise the care of Discovery Health Medical Scheme members who have renal (kidney) disease. 

• Find out more about how people who live with chronic illness can protect their health and work to curb the spread of COVID-19 in their communities.

Why are those who have chronic kidney disease at risk of severe illness?

There is particular concern for adults and children who have kidney disease, for several reasons, Prof Gottlich explains:

• Many people who live with kidney disease are aged. Not only do our immune systems weaken as we age but, unfortunately, ageing is also one cause of chronic kidney disease. According to the US Centers for Disease Control and Prevention, early data from China and the United States suggests that most COVID-19-related deaths have occurred among adults aged 60 years and over, and among persons with serious underlying health conditions.
• Also, many older South Africans who have renal disease also have other chronic conditions such as hypertension (high blood pressure) or diabetes, HIV and tuberculosis (TB), which worsens their risk of developing severe complications if they acquire COVID-19.
• In its severe form, COVID-19 mainly causes an acute respiratory illness with pneumonia, but it can affect many organs such as the kidney, heart, digestive tract and nervous system, as well as blood. This is very concerning for people with any sort of chronic illness because they generally do not have a strong immune system. These sorts of complications can lead to hospitalisation and time in ICU. For now, the impact of COVID-19 on chronic kidney disease has not been extensively reported, so we don’t fully understand its impact.
• People who have had kidney transplants take medicine that suppresses their immune system because this is part of the protocol to prevent rejection of the transplanted organ. They therefore have a higher risk of infection from bacteria and viruses in general – and especially from a highly transmissible virus such as the one that causes COVID-19.

• Read more on the impact of COVID-19 on people who have had solid-organ or bone marrow stem cell transplants.

The spread of COVID-19 presents particular challenges for people who need dialysis

• Some people who have chronic kidney disease require dialysis – a medical treatment that takes over the functioning of the failing kidneys, and filters and purifies the blood. People with chronic renal disease will need dialysis anywhere from two to three times a week, depending on the severity of the disease.
• Dialysis takes two forms. The first is haemodialysis, which refers to a dialysis machine filtering and removing waste products and water from a patient’s blood.
  • A very small minority of the renal population can undergo haemodialysis at home, making physical distancing possible.
  • Around 99% of people with kidney disease must go to dialysis centres two or three times a week. In these cases, physical distancing is not possible. Also, these patients are exposed to healthcare staff who may acquire COVID-19 in the course of their work and unwittingly pass it on. Many dialysis centres also share blankets, towels or pillows and this puts patients at risk of acquiring COVID-19 from these surfaces.

• Some renal patients undergo a different form of dialysis – called peritoneal dialysis. In this case, a sterile cleansing fluid is inserted into the abdomen so that wastes can be washed out of the body. These patients require delivery of the cleansing fluid each month. It’s critical to have no interruptions to the medical supply chain (due to enhanced containment measures to curb the spread of COVID-19), so they receive their dialysis fluids on time. To prevent contracting COVID-19, once these patients take delivery, they also need to maintain their distance from any person who delivers that bag and who sanitises the fluid bags, their hands and so on.

How Discovery Health’s KidneyCare team supports members with chronic kidney disease

Many patients who have chronic kidney disease feel significant anxiety about their risk of contracting COVID-19 while in a setting with other ill people. We are extremely concerned that this might lead them to miss dialysis sessions or avoid follow-up medical appointments scheduled as part of their regular treatment. We urge our members to continue to attend their dialysis sessions and to really enforce the preventive measures that curb the spread of all disease, including COVID-19. We are working to inform all Discovery Health Medical Scheme members who are on the KidneyCare programme of the preventive measures that they need to practise to limit their risk of contracting COVID-19. These include:

1. Understand that the disease spreads by droplets that are exhaled when a sick person coughs or sneezes, or when we touch surfaces on which these droplets have landed and then touch our faces.
2. Understand how to wash your hands correctly and do so often. Use soap and water, and scrub your hands for at least 20 seconds. If you can’t access soap and water, use an alcohol-based hand sanitiser and make sure you cover all areas of your hands as you scrub.
3. Remember to wash your hands after touching money, or other frequently handled items like credit cards, credit card machines and after interacting with a delivery person.
4. Avoid touching your face – especially eyes, nose, and mouth – with unwashed hands.
5. Practise cough etiquette: When you cough, maintain your distance from others. Cover your mouth and nose with clothing, a flexed elbow or a tissue. Throw away the tissue immediately and wash your hands afterwards. Make sure those around you do the same.
6. Practise physical distancing (social distancing) and adhere to the conditions of any stay-at-home periods of containment. When you can move freely, avoid crowds, especially in confined and poorly ventilated spaces, do your grocery shopping at off-peak hours and avoid public transport. Avoid meetings, events and other social gatherings in areas with ongoing community transmission of COVID-19.
7. Wear a face mask when in public or when going to the dialysis unit.
8. Plan around who will provide care for you if your primary care giver gets sick.
9. Stay at home as far as possible, including working from home.
10. Have your yearly flu vaccine as soon as possible. This will lower your risk of acquiring the seasonal flu and developing severe respiratory illness as a result, or your risk of acquiring COVID-19 at the same time as the flu. The effect of this could also be severe illness requiring hospitalisation.
11. Make sure that, when at a dialysis centre, you do not share any items with other patients such as plates, towels, linen and so on.
12. If peritoneal dialysis fluids are delivered to your home, keep your distance from delivery people, sign any forms that need signing with your own pen, and sanitise your hands and bags delivered to you as soon as possible
13. Look after your general wellbeing, including physical, nutritional and mental health.

“All those who live with a person who has chronic kidney disease and who is on dialysis must follow the same precautions to prevent transmission of illness within the family but need to be especially diligent in doing so,” adds Prof. Gottlich.

Supporting healthcare providers to treat patients with kidney disease

“We have met with the Dialysis Association of South Africa and emphasised the need for protective guidelines for dialysis centre staff and patients to curb the spread of COVID-19 and other infections. We will also support those doctors who are treating people with kidney disease and who are at risk of contracting COVID-19 in the workplace in general,” explains Prof Gottlich.

“It’s very important that staff at dialysis centres self-monitor their symptoms and adhere to guidelines put forward by the International Society of Nephrology developed for dialysis units during the COVID-19 outbreak. This includes admitting patients who require dialysis but who have acquired COVID-19, and treating them in an isolation ward if possible.”

• A dedicated email address – kidneycarecorona@discovery.co.za – has been set up for members of Discovery Health Medical Scheme and healthcare professionals to send any queries related to COVID-19.

Steps to take if you suspect you have acquired COVID-19

People with kidney disease must notify their dialysis centre (before going to the dialysis centre) and doctor (telephonically or by a virtual consultation) if they develop any of the following symptoms, linked to COVID-19:

• Fever above 38°C
• Cough
• Sore throat
• Shortness of breath

Please make sure you do not go to your doctor’s consulting rooms because you risk exposing other patients to COVID-19 and you will also be at risk of interacting with sick people. Give your doctor fair warning that they will be dealing with a patient who has potentially been exposed to COVID-19. This will let them prepare in every way to care for you, and protect themselves and others from exposure though you. Your doctor will guide you as to the next steps to take to get the specific care you need, also indicating whether they feel a COVID-19 test is warranted. Unless your doctor indicates otherwise, stay at home (self-isolate) and please avoid contact with others.

All medical information found on this website including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to protect and empower all South Africans by promoting a better understanding of COVID-19.