Alfano Gaetano, Fontana Francesco, Ferrari Annachiara, Morisi Niccolò, Gregorini Mariacristina, Cappelli Gianni, Magistroni Riccardo, Guaraldi Giovanni, Donati Gabriele
Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy.
Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy.
Clin Kidney J. 2022 Apr 30;15(8):1450-1454. doi: 10.1093/ckj/sfac115. eCollection 2022 Aug.
Safe and timely discontinuation of quarantine of in-center hemodialysis (HD) patients with a previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a challenging issue for the nephrological community because current guidelines for ending isolation do not mention dialysis patients. To prevent potentially fatal outbreaks of coronavirus disease 2019 (COVID-19), a cautionary approach has been adopted by most dialysis units. The criteria for ending the isolation in the HD population generally coincide with those recommended for immunocompromised people. Thus, a test-based strategy relying on two consecutive negative reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs has been adopted to terminate quarantine. This strategy has the disadvantage of prolonging isolation as RT-PCR positivity does not equate to SARS-CoV-2 infectivity. Consequentially, prolonged positivity of SARS-CoV-2 results in excessive workload for the HD staff who must face an increasing number of COVID-19 patients requiring isolation. This condition leads also to serious implications for the patients and their households including work productivity loss, postponement of health-care appointments and an increased risk of COVID-19 reinfection. To counteract this problem, other diagnostic tests should be used to provide the best care to HD patients. Recent results seem to encourage the use of RT-PCR cycle threshold (Ct) values and rapid antigen tests given their better correlation with cell culture for SARS-CoV-2 than RT-PCR testing. Here, we provide an overview of the current scientific evidence on the tests used to verify the infectiousness of the virus in order to stimulate the nephrological community to adopt a streamlined and pragmatic procedure to end isolation in COVID-19 patients on HD.
对于肾脏病学界而言，安全、及时地解除曾感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的中心血液透析（HD）患者的隔离是一个具有挑战性的问题，因为目前的解除隔离指南未提及透析患者。为防止2019冠状病毒病（COVID-19）可能致命的爆发，大多数透析单位都采取了谨慎的做法。HD人群解除隔离的标准通常与针对免疫功能低下人群推荐的标准一致。因此，已采用基于连续两次逆转录聚合酶链反应（RT-PCR）鼻咽拭子检测结果均为阴性的检测策略来终止隔离。该策略的缺点是会延长隔离时间，因为RT-PCR阳性并不等同于SARS-CoV-2具有传染性。因此，SARS-CoV-2检测结果长期呈阳性会给HD工作人员带来过多工作量，他们必须面对越来越多需要隔离的COVID-19患者。这种情况也会给患者及其家庭带来严重影响，包括工作效率损失、医疗预约推迟以及COVID-19再次感染风险增加。为解决这一问题，应使用其他诊断检测方法，以便为HD患者提供最佳护理。近期结果似乎鼓励使用RT-PCR循环阈值（Ct）值和快速抗原检测，因为它们与SARS-CoV-2细胞培养的相关性比RT-PCR检测更好。在此，我们概述了目前用于验证病毒传染性的检测方法的科学证据，以促使肾脏病学界采用简化且务实的程序来解除HD上COVID-19患者的隔离。
