The communication by Clarke et al.1 published this past July reports a high prevalence of serologically detected coronavirus disease 2019 (COVID-19) infection among patients of two London hemodialysis units. A universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening program, with detection of IgG and IgM against the virus and bimonthly RT-PCR test, was also performed in the two units affiliated to our center, Hospital Clínic of Barcelona. Interestingly, some remarkable differences between our findings and the ones published in this journal are worth noting.
Even though there is a much higher overall prevalence in the city of London than here in Barcelona (14.5%, and 7% respectively),1,2 the prevalence in the studied population of patients on in-center hemodialysis is strikingly higher (36.2%, 129 of 356). In contrast, our in-center hemodialysis prevalence was much closer to that of the general population (9.2%, 13 of 141).
The infection precaution measures adopted by the London cohort on the basis of the National Institute for Health and Care Excellence guidelines seem similar to ours.3,4 However, there are some significant differences. First, every patient, nurse, and cleaning staff member, regardless of COVID-19 status, has always been required to wear a mask during the totality of the hemodialysis session. Second, our screening system adds the bimonthly RT-PCR test, with which we have diagnosed two asymptomatic patients and thus, provided proper isolation for their hemodialysis sessions. Finally, a SARS-CoV-2 RT-PCR–positive patient could only be deisolated after two consecutively negative results at least 2 weeks after the initial diagnosis.
Although epidemiologic disparities are expected between countries, it is important to inform of different experiences, such as those exposed in this letter. These deisolation, detection, and physical barrier preventive measures were stricter than those applied in London. Thus, they may have reduced the viral exposure of such a high-risk population and at least in part, may explain the difference in prevalence seen between both cohorts.
Disclosures
F. Maduell reports being on speakers bureaus for Amgen, Baxter, Braun, Fresenius Medical Care, Metronic, and Nipro. All remaining authors have nothing to disclose.
Funding
None.
Footnotes
D.R.-E. and J.J.B. contributed equally to this work.
Published online ahead of print. Publication date available at www.jasn.org.
See related Letters to the Editor, “Authors' Reply,” on pages 2967–2968.
- Copyright © 2020 by the American Society of Nephrology
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