Tribune. Chronic kidney disease (CKD) is characterized by the progressive loss of the blood-cleaning function of the kidneys. At its terminal stage, which concerned 89,692 patients in France at the end of 2018, replacement therapy for renal function is necessary. While more than 40,400 patients benefit from a kidney transplant, nearly 50,000 patients are treated by dialysis, 93% of which by the hemodialysis technique in a care unit (i.e. in a dialysis center , either in medicalized dialysis unit – UDM, or more rarely in self-dialysis) three times a week during sessions lasting four hours.
Home dialysis is an alternative to hemodialysis in a care unit carried out according to two technical methods: peritoneal dialysis (PD) and home hemodialysis (HDD). PD uses the natural cleansing properties of the peritoneal membrane that lines the abdomen and its viscera; it is performed independently (manually or with a device – cycler – at night or by a nurse – we speak of assisted PD). HDD miniaturized is performed by independent patients five to seven times a week for two hours. Home dialysis concerns around 20% of patients in many European countries, Canada and Australia, but only 7% of dialysis patients in France (6% in PD and 1% in HDD).
Health centers increase the risks
Dialysis patients have an increased risk of contracting Covid-19 (due to SARS-CoV-2) due to their attendance, three times a week, in dialysis centers located in health establishments, generally organized in rooms municipalities, and the need for medical transport. This risk is reduced but not eliminated by strict compliance with barrier measures, the wearing of surgical masks by caregivers and patients, and the use of individual transport.
The SARS-CoV-2 infection rate was 3.3% in the French dialysis population, thirteen times higher than that of the French population.
Dialysis patients have paid a heavy price for Covid-19. During the first wave of the epidemic, 1,621 dialysis patients were infected and 344 died; the SARS-CoV-2 infection rate was 3.3% in the French dialysis population, thirteen times higher than that of the general French population. The death rate of dialysis patients who had Covid-19 was high (21%), linked to their advanced age and their comorbidities. These figures are corroborated by the European Eracoda study which collected 1,073 cases of Covid-19 in 305 transplanted and dialyzed 768. The probability of death within 28 days of diagnosis is 21.3% in transplant recipients and 25% in European dialysis patients.
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