Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada.
Swiss Med Wkly. 2021 Aug 27;151(33-34). doi: 10.4414/SMW.2021.w30006.
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.
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.
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.
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.
接受维持性透析的患者因 COVID-19 感染而面临严重并发症的高风险，包括死亡。我们介绍了瑞士日内瓦在 COVID-19 爆发期间透析单位管理和重组、当地流行病学和结果的概况，那里的 SARS-CoV-2 发病率是欧洲最高的之一。
所有接受维持性透析的 SARS-CoV-2 阳性门诊患者都从其常规透析机构转移到日内瓦大学医院透析单位，以避免新的传播集群的形成。在该单位内，按照机构传染病预防和控制小组的建议，实施了适当的缓解措施。
从 2020 年 2 月 25 日至 12 月 31 日，在两个不同的波次中，279 名维持性透析患者中有 82 名 SARS-CoV-2 检测呈阳性，第一波次的发病率为每 100,000 人日 73 例，第二波次的发病率为每 100,000 人日 342 例，大约是普通人群的四到六倍。两次波次中大多数感染（55%）都与集群有关。大多数感染（62%）发生在男性。16 名患者（34%）因 COVID-19 相关并发症而死亡。与感染存活的患者相比，死亡患者年龄较大且体重指数较低。
SARS-CoV-2 在透析人群中与高感染率和死亡率相关。严格的缓解措施似乎有效地控制了集群外维持性透析患者之间的感染传播。需要大规模的流行病学研究来评估预防措施在降低透析人群中的感染率和死亡率方面的疗效。
