Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C).

OBJECTIVE: HCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme. DESIGN: The ERASE-C Campaign is an outreach programme for the screening, diagnosis and group treatment of HCV encompassing 2323 uremic patients and 353 medical staff members from 18 haemodialysis centres. HCV-viremic subjects were linked to care for directly acting antiviral therapy or received on-site sofosbuvir/velpatasvir therapy. The objectives were HCV microelimination (>80% reduction of the HCV-viremic rate 24 weeks after the end of the campaign in centres with ≥90% of the HCV-viremic patients treated) and 'No-C HD' (no HCV-viremic subjects at the end of follow-up). RESULTS: At the preinterventional screening, 178 (7.7%) uremic patients and 2 (0.6%) staff members were HCV-viremic. Among them, 146 (83.9%) uremic patients received anti-HCV therapy (41 link-to-care; 105 on-site sofosbuvir/velpatasvir). The rates of sustained virological response (SVR12, undetectable HCV RNA 12 weeks after the end of treatment) in the full analysis set and per-protocol population were 89.5% (94/105) and 100% (86/86), respectively, in the on-site treatment group, which were comparable with the rates of 92.7% (38/41) and 100% (38/38), respectively, in the link-to-care group. Eventually, the HCV-viremic rate decreased to 0.9% (18/1,953), yielding an 88.3% reduction from baseline. HCV microelimination and 'No-C HD' were achieved in 92.3% (12/13) and 38.9% (7/18) of the haemodialysis centres, respectively. CONCLUSION: Outreach strategies with mass screenings and on-site group treatment greatly facilitated HCV microelimination in the haemodialysis population. CLINICALTRIALSGOV IDENTIFIER: NCT03803410 and NCT03891550.

Deployment of a New CRRT/PIRRT Device during the COVID-19 Pandemic Emergency: Organizational Challenges and Implementation Results.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control. MATERIAL AND METHODS: Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability. RESULTS: On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 - 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 - 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine. CONCLUSION: Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe.

[COVID-19 emergency management at the Nephrology and Dialysis Unit in Savona, Albenga and Cairo Montenotte].

Our Nephrology and Dialysis Unit includes three Haemodialysis Centres based in Savona, Albenga and Cairo Montenotte. These provide assistance to 150 patients. We have a Peritoneal Dialysis Clinic with 35 patients, two Post-Transplant Clinics with about 120 patients in follow-up in Savona and Albenga, and three Pre-Dialysis Clinics across the three locations. Finally, there is an autonomous hospital ward with 15 beds that has continued its activity, even if at reduced regimes. With this report we intend to share the strategy we used to prevent the spread of the SARS CoV-2 virus among the patients and the staff at our Unit, following the National, Regional and Corporate guidelines published during "Phase 1". We decided that the Haemodialysis Centres needed to remain a safe place. To insure this, medical and nursing staff and patients had to behave conscientiously and collaboratively, and according to the official Hospital guidance. Our main concern was to protect patients who, despite suffering complications and being at high risk because of their age, immunodepression and multiple comorbidities, were forced to leave their house three times a week to be treated with dialysis. The results of this strategy have ensured that, of the 150 patients undergoing haemodialysis, only 3 have been tested positive: no patients in Albenga, 2 in Savona and 1 in Cairo Montenotte, all of them lived and were infected in their nursing homes. Also, there was no positivity among any of the staff members across the three locations. Our results are extremely positive and confirm the validity that prevention and protection procedures had in the earlier stages of the pandemic.

Impacto de la pandemia COVID-19 en los servicios de Nefrología españoles / Impact of the COVID-19 pandemic on Spanish Nephrology Services

La pandemia de la infección por el coronavirus tipo2 del síndrome respiratorio agudo grave o SARS-CoV-2, causante de la enfermedad por coronavirus de 2019 (COVID-19), ha precisado una transformación drástica de los hospitales y, por consiguiente, de los servicios de Nefrología de España. Desde la Sociedad Española de Nefrología se ha realizado una encuesta a los jefes de servicios de Nefrología de España abordando la reorganización de los servicios de Nefrología y la actividad en la época de mayor afectación por COVID-19. Hemos preguntado por la integración de los nefrólogos en equipos COVID-19, la actividad asistencial de hospitalización de Nefrología (ingresos programados, biopsias renales), la realización de cirugías programadas como los accesos vasculares o la implantación de catéteres peritoneales, la suspensión o no del programa de trasplante renal y la transformación de las consultas externas de Nefrología. En el trabajo actual se detallan la adaptación y la transformación de los servicios de Nefrología en la pandemia COVID-19 en España. Durante dicho periodo se han suspendido los ingresos programados en los servicios de Nefrología, la realización de cirugías/biopsias programadas y ha disminuido en más de un 75% el programa de trasplante renal. Es de interés mencionar que las consultas externas de Nefrología se han realizado mayoritariamente telefónicamente. En conclusión, la pandemia ha impactado claramente en la actividad clínica en los servicios de Nefrología españoles disminuyendo la actividad programada y los trasplantes renales y modificando la actividad en consultas externas. Un plan de transformación asistencial e implementación de telemedicina en Nefrología parece necesario y de gran utilidad en un futuro próximo

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has required a rapid and drastic transformation of hospitals, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The Spanish Society of Nephrology conducted a survey directed to the Heads of Nephrology Departments in Spain that addressed the reorganisation of Nephrology departments and activity during the peak of COVID-19 pandemic. The survey has been focused on the integration of nephrologists in COVID-19 teams, nephrology inpatient care activities (elective admissions, kidney biopsies), the performance of elective surgeries such as vascular accesses or implantation of peritoneal catheters, the suspension of kidney transplantation programmes and the transformation of nephrology outpatient clinics. This work details the adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain. During this period, elective admissions to Nephrology Services, elective surgeries and biopsies were suspended, and the kidney transplant programme was scaled back by more than 75%. It is worth noting that outpatient nephrology consultations were carried out largely by telephone. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics. A restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future

[Reorganization of haemodialysis during COVID-19 emergency: a report from Dialysis Centers of Parma province].

The epidemic wave that hit Italy from February 21st, 2020, when the Italian National Institute of Health confirmed the first case of SARS­CoV­2 infection, led to a rapid and efficient reorganization of Dialysis Centers' activities, in order to contain large-scale spread of disease in this clinical setting. We herein report the experience of the Hemodialysis Unit of Parma University Hospital (Azienda Ospedaliero-Universitaria, Parma, Italy) and the Dialysis Centers of Parma territory, in the period from March 1st, 2020 to June 15, 2020. Among patients undergoing chronic haemodialysis, 37/283 (13%) had positive swabs for SARS­CoV­2, 9/37 (24%) died because of COVID-19. Twenty-three patients required hospitalization, while the remaining were managed at home. The primary measures applied to contain the infection were: the strengthening of personal protective equipment use by doctors and nurses, early identification of infected subjects by performing oro-pharyngeal swabs in every patient and in the healthcare personnel, the institution of a triage protocol when entering Dialysis Room, and finally the institution of two separate sections, managed by different doctors and dialysis nurses, to physically separate affected from unaffected patients and to manage "grey" patients. Our experience highlights the importance and effectiveness of afore-mentioned measures in order to contain the spread of the virus; moreover, we observed a higher lethality rate of COVID-19 in dialysis patients as compared to the general population.

COVID-19 and ESKD, A Rapid Review.

In 2020, the COVID-19 pandemic has ravaged the world. Individuals with end-stage kidney disease (ESKD) are at higher risk due to impaired immunity, comorbid conditions, and dependence on travel to medical care settings. We review the salient features of COVID-19 in this population, including the risk of infection, disease course, changes in dialysis unit management, use of investigatory medications, access considerations, home dialysis, and capacity planning.

Significados de los procesos educativos para profesionales de la salud que se desempeñan en un centro de diálisis / Meaning of the educational processes for health professionals who work in a dialysis centre

OBJETIVO: Cuando un paciente ingresa a diálisis se generan importantes cambios que afectan el estilo de vida de ellos y su familia. Para abordar este ingreso, los profesionales de la salud deben implementar procesos de enseñanza orientados a mejorar la calidad de vida de los pacientes, además de salvarla. OBJETIVO: Debido a lo relevante de estos procesos educativos, el estudio que se presenta a continuación buscó comprender los significados que otorgan los profesionales de la salud a los procesos educativos que desarrollan en usuarios con insuficiencia renal crónica en un centro de diálisis. MATERIAL Y MÉTODO: La investigación de tipo cualitativa, de diseño fenomenológico e interpretativo. La información generada a través de entrevistas en profundidad a profesionales médicos y de enfermería, fue analizada por medio del método de análisis de contenidos. RESULTADOS: Los resultados obtenidos permitieron comprender significados asociados a los periodos de educación, métodos utilizados y principalmente los elementos que facilitaban y obstaculizaban estos procesos. CONCLUSIÓN: Se concluye que los profesionales de la salud trabajan en base a un método no formalizado, donde el diálogo y la experiencia o trayectoria resultan fundamentales para generar estos procesos de enseñanza

INTRODUCTION: The patient's admission to dialysis causes important changes that impact their lifestyle and family. To address this admission, health professionals must implement teaching processes aimed at improving the quality of life of patients, as well as save. OBJECTIVE: Due to the relevance of educational processes, the present study sought to understand the meanings that health professionals give to educational processes, which they implement in users with chronic kidney disease in a dialysis centre. MATERIAL AND METHOD: Qualitative research, phenomenological and interpretive design. The information generated through in-depth interviews with medical and nursing professionals was analysed using the content analysis method. RESULTS: The results obtained allow to understand meanings associated with periods of education, methods and mainly the elements that facilitated and hindered these processes. CONCLUSION: It is concluded that health professionals work based on a non-formalized method, where dialogue and experience or trajectory are essential to generate these teaching processes

Influencia del proceso educativo en la consulta de ERCA sobre la elección de tratamiento renal sustitutivo / Influence of the educational process in the ACKD consultation on the choice of renal replacement therapy

INTRODUCCIÓN: La finalidad de las consultas de Enfermedad Renal Crónica es potenciar los autocuidados y autonomía del paciente. El proceso de información y elección de tratamiento renal sustitutivo en estos pacientes es un aspecto clave para su tratamiento. OBJETIVO: Determinar si el tipo de proceso educativo que recibe el paciente en la consulta ERCA influye sobre la opción de tratamiento renal sustitutivo elegida. MATERIAL Y MÉTODO: Estudio observacional retrospectivo en pacientes seguidos en consulta de Enfermedad Renal Crónica en el periodo 2015-2020. Se recogieron datos clínicos y sociodemográficos de la historia clínica del paciente, opción terapéutica elegida por el paciente y proceso educativo recibido (sólo nefrólogo o equipo multidisciplinar: nefrólogo y enfermera). RESULTADOS: Se incluyeron 294 pacientes candidatos a tratamiento renal sustitutivo. El 51% de la muestra optó por hemodiálisis en centro como la opción más frecuente. Los pacientes que fueron educados por el equipo multidisciplinar presentan tasas de elección de hemodiálisis de 36,4% y de tratamiento conservador del 18,2% frente al 56,7% y 5,1% respectivamente, del grupo informado sólo por el nefrólogo (p < 0,01). CONCLUSIONES: La hemodiálisis en centro es la opción más frecuente entre los pacientes. Cuando el paciente recibe un proceso informativo estructurado, sistemático y multidisciplinar la elección de las diferentes opciones tiende a equilibrarse y el tratamiento conservador es considerado una opción alternativa

INTRODUCTION: The purpose of the Chronic Kidney Disease consultations is to enhance the patient's self-care and autonomy. The process of information and choice of renal replacement therapy in these patients is a key aspect for their treatment. OBJECTIVE: To determine if the type of educational process that the patient receives in ACKD consultation influences the choice of the type of renal replacement treatment. MATERIAL AND METHOD: Retrospective observational study in patients followed up in ACKD consultation in the period 2015-2020. Clinical and sociodemographic data were collected from the patient's medical history as well as the therapeutic option chosen by the patient and the educational process received (only nephrologist or multidisciplinary team: nephrologist and nurse). RESULTS: 294 patients who were candidates for renal replacement therapy were included. 51% of the sample chose in-centre haemodialysis as the most frequent option. The patients who were educated by a multidisciplinary team chose haemodialysis in 36.4% and conservative treatment in 18.2% versus 56.7% and 5.1% respectively, for the group that was informed by only the nephrologist (p < 0.01). CONCLUSIONS: In-centre haemodialysis is the most frequent option among patients. When the patient receives a structured, systematic and multidisciplinary information process, the choice between the different options tends to balance out and conservative treatment is considered an alternative option

Efeitos da aplicação periódica da simulação in situ para educação permanente em ressuscitação cardiopulmonar no contexto da hemodiálise / Effects of the periodic application of in situ simulation for permanent education in cardiopul-monary resuscitation in the context of haemodialysis

INTRODUÇÃO: A parada cardiorrespiratória é um evento crítico para o paciente dialítico, que necessita de uma equipe de enfermagem na hemodiálise apta a realizar o procedimento de ressuscitação cardiopulmonar. Justifica-se nesse contexto a educação permanente em enfermagem, que por meio da simulação in situ, pode contribuir com a construção das competências em ressuscitação cardiopulmonar. OBJETIVO: Verificar se diferentes periodicidades de formação utilizando a simulação in situ, influenciam na construção de competências para a ressuscitação cardiopulmonar no ambiente da hemodiálise. MATERIAL E MÉTODO: Trata-se de um estudo experimental não randomizado, realizado com profissionais de enfermagem de uma unidade de diálise situada em um Hospital Universitário de grande porte da região sul do Brasil. Os participantes foram alocados em 3 grupos que receberam periodicidades diferentes de intervenção (2, 4, e 8 meses). RESULTADOS: Os resultados apontaram diferenças estatisticamente significativa na análise do conhecimento, no grupo de periodicidade de 4 meses. Na avaliação das habilidades, observou-se resultado significativo (p = 0,048) para o grupo de periodicidade de 4 meses, na técnica da compressão torácica. CONCLUSÃO: Com este estudo demonstramos que a simulação in situ promoveu a construção de competências no intervalo a cada 4 meses, corroborando com o fato de que a aprendizagem por meio da experimentação e a reflexão, e dentro do contexto profissional, podem contribuir com a educação permanente em saúde. Mais estudos no contexto da diálise são necessários para confirmar e generalizar os achados

INTRODUCTION: Cardiac arrest is a critical event for the dialysis patient who needs a nursing staff in haemodialysis able to perform cardiopulmonary resuscitation. In this context, permanent nursing education is justified, which, through in situ simulation, can contribute to the construction of skills in cardiopulmonary resuscitation. OBJECTIVE: To verify whether different training periods using in situ simulation, influence the construction of skills for cardiopulmonary resuscitation in the haemodialysis environment. MATERIAL AND METHOD: A non-randomized experimental study was carried out with nursing professionals from a dialysis unit located in a large University Hospital in the southern region of Brazil. Participants were allocated to 3 groups that received different intervals of intervention (2, 4, and 8 months). RESULTS: The results showed statistically significant differences in the analysis of knowledge, in the 4-month group. In assessing skills, a significant result (p = 0.048) was observed for the 4-month group, using the chest compression technique. CONCLUSION: This study shows that in situ simulation promotes the construction of skills in an interval of 4 months, corroborating that learning through experimentation and reflection, and within the professional context, can contribute to permanent education in health. More studies are needed in the context of dialysis to confirm and generalize the findings

No disponible

Infection prevention and control in blood purification centers during the COVID-19 epidemic: a single institution experience from Zhejiang, China.

not available.

Prof. Peter Ivanovich, MD, FRCP - A Friend of Doctors Nephrologists from North Macedonia.

Prof. Peter Ivanovich was born in Tacoma, Washington, USA on November 9, 1928, and died in Chicago on November 16, 2019. After being educated by the father of chronic hemodialysis, Belding Scribner, in Seattle, P. Ivanovich devotes himself to the study of hemodialysis and its treatment in patients with chronic terminal renal failure. From 1971 he worked at the Northwestern University School of Medicine in Chicago where he created a hemodialysis unit at the Veteran Affairs Hospital. In the well-equipped hemodialysis unit, the latest hemodialysis techniques were studied and new drugs were tested. Numerous doctors from all over the world, as well as from Macedonia, visited and researched at the unit with P. Ivanovich. P. Ivanovich has frequently visited Macedonia and the former Yugoslavia, where he participated with his lectures. He helped in the development of nephrology in the Balkan Peninsula. Significant is his participation in the First Scientific Meeting of the Nephrologists of Yugoslavia, Struga, 26-28. IX 1977 and in the creation of BANTAO in Ohrid on 9. IX 1993 - during the First Congress of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs. Prof. P. Ivanovich is in the lasting memory of the nephrologists of North Macedonia as a renowned nephrologist, cosmopolitan and friend of patients and doctors.

Estudio descriptivo del primer mes de situación de pandemia por COVID-19 en una unidad de diálisis hospitalaria / Descriptive study of the first month of situation of the COVID-19 pandemic in a hospital dialysis unit

Los pacientes en diálisis constituyen un grupo de riesgo de sufrir infección por SARS-CoV-2 y posiblemente de tener más complicaciones. Los profesionales sanitarios se han enfrentado a una pandemia sin precedentes y de la que había poca información. El objetivo de este estudio ha sido describir la experiencia del primer mes viviendo la pandemia generada por SARS-CoV-2 en una unidad hospitalaria de hemodiálisis de Madrid, tanto en relación a los pacientes como al personal sanitario. Así mismo, se pretende reflejar las actuaciones sanitarias durante dicho mes. El total de pacientes en la unidad fue de 90, realizándose la determinación PCR a todos, 37 (41,1%) dieron positivo a COVID-19, de estos 22 (59,4%) eran sintomáticos y 15 (40,5%) eran asintomáticos. De los pacientes positivos, 16 (43,2%) precisaron ingreso hospitalario y 6 (16,2%) fallecieron. Los pacientes fallecidos eran de mayor edad que los supervivientes. La muestra de profesionales sanitarios fue de 44, de los que 15 (34%) presentaron sintomatología. El servicio de Salud Laboral sólo determinó PCR a este grupo, obteniendo 4 profesionales (9%) PCR positivo, sin embargo tras considerar los criterios clínicos/radiológicos un total de 9 profesionales fueron diagnosticados como COVID-19 positivos, requiriendo 1 de ellos ingreso hospitalario. CONCLUSIONES: se detectó una elevada prevalencia de COVID-19 positivo en los pacientes de la unidad de diálisis, donde destaca el elevado número de pacientes asintomáticos detectados mediante cribado PCR al total de los pacientes. Algunos profesionales presentaron algún tipo de sintomatología correspondiente con clínica COVID-19, pero se detectaron pocos casos con PCR positiva

Dialysis patients are at risk group for SARS-CoV-2 infection and possibly have more complications. Healthcare professionals have faced an unprecedented pandemic, for which little information existed. The objective of this study was to describe the experience of a Madrid hospital haemodialysis unit during the first month of the SARS-CoV-2 pandemic, both in relation to patients and healthcare personnel. Likewise, it is intended to report the health actions. The total number of patients in the unit was 90. In all patients, the PCR test was performed. 37 (41.1%) tested positive for COVID-19, of these 22 (59.4%) were symptomatic and 15 (40.5%) were asymptomatic. Of the positive patients, 16 (43.2%) required hospital admission, 6 of whom died (16.2%). The deceased patients were older than the survivors. Health professionals were 44, of whom 15 (34%) had symptoms. The Occupational Health service only performed PCR on the symptomatic group, having 4 professionals (9%) positive PCR. However, after considering the clinical / radiological criteria, 9 professionals were diagnosed as COVID-19 positive, 1 of them requiring hospital admission. CONCLUSIONS: A high prevalence of positive COVID-19 was detected in patients in the dialysis unit, highlighting the high number of asymptomatic patients detected by PCR screening. Some healthcare professionals presented some type of symptoms corresponding to the COVID-19 disease, however, few cases were detected with positive PCR

Experiencias de vida y soporte percibido por las enfermeras de las unidades de hemodiálisis hospitalaria durante la pandemia de COVID-19 en España / Life experiences and support perceived by nurses in hospital haemodialysis units during the COVID-19 pandemic in Spain

OBJETIVO: Profundizar en el conocimiento sobre las experiencias de vida y el soporte percibido por las enfermeras/os que atendieron a pacientes con enfermedad de COVID-19 en tratamiento con hemodiálisis hospitalaria durante los meses de mayor prevalencia de la pandemia en España. MATERIAL Y MÉTODO: Estudio cualitativo fenomenológico. El grupo participante fue de diez enfermeras/o de hospitales públicos de España que habían dializado a pacientes con COVID-19. La recolección de los datos se realizó mediante entrevistas semiestructuradas a través del programa Skype©, hasta conseguir la saturación de las unidades de significado. El análisis se hizo mediante el método de Colaizzi-7 pasos. RESULTADOS: Del análisis de los discursos emergieron cuatro dimensiones asociadas a diferentes subcategorías: desconocimiento sobre la enfermedad, sufrimiento del paciente, soporte percibido y capacidad de afrontamiento de los profesionales. CONCLUSIONES: En las enfermeras han coexistido emociones positivas y negativas. En la etapa álgida del brote epidémico las vivencias de las enfermeras de hemodiálisis fueron provocadas por el desconocimiento, por no saber actuar adecuadamente y por el miedo al contagio, agravado por la falta de medios de protección. Las vivencias positivas fueron el crecimiento personal, el apoyo del equipo y de la familia. También cabe destacar el control racional de la situación, debido a que en las unidades de diálisis hay gran experiencia en el control de la trasmisión de enfermedades infecciosas

AIM: To deepen the knowledge about life experiences and support perceived by nurses who attended in-hospital patients with COVID-19 disease on haemodialysis during the months with the highest prevalence of the pandemic in Spain. MATERIAL AND METHOD: Qualitative phenomenological study. The participating group was ten nurses from public hospitals in Spain who had dialyzed patients with COVID-19. Data collection was performed using semi-structured interviews through Skype© program, until the units of meaning were saturated. The analysis was done using the Colaizzi's seven-step method. RESULTS: Four dimensions emerged from the speech analysis associated with different subcategories: ignorance about the disease, patient suffering, perceived support and professionals' ability to cope. CONCLUSIONS: Positive and negative emotions have coexisted in nurses. In the peak stage of the epidemic outbreak, the experiences of hemodialysis nurses were caused by ignorance, not knowing how to act appropriately, and fear of infection, aggravated by the lack of means of protection. The positive experiences were personal growth, the support of the team and the family. It is also worth noting the rational control of the situation, because in the dialysis units there is great experience in controlling the transmission of infectious diseases

Viral hepatitis in patients on hemodialysis.

Hepatitis B and hepatitis C (HCV) prevalence are higher in people on hemodialysis (HD) than the general population. Through implementation of prevention interventions including vaccines, serologic screening, and post-exposure management, transmissions linked to HD have decreased dramatically. In this manuscript, we review epidemiology of viral hepatitis, summarize current screening and vaccine recommendations, and appraise the available data about efforts to decrease incidence within HD facilities, including isolation of people with viral hepatitis within HD units. Also included is a discussion of the highly effective all-oral HCV treatment options and treatment for HCV in people awaiting kidney transplant.

[High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic]. / Alta prevalencia de COVID-19 asintomático en hemodiálisis. Aprendiendo día a día el primer mes de pandemia de COVID-19.

Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.

Safeguarding the Maintenance Hemodialysis Patient Population during the Coronavirus Disease 19 Pandemic.

The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 (COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5-6% of them may need more aggressive therapies in intensive care. Most governments have recommended social separation and severe measures of prevention of further spreading of the epidemic. Because hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this category of patients requires special attention. In this editorial, we tried to summarize the experience of our centers that hopefully may contribute to help other centers and colleagues that are facing the coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, recommendations for isolation and preventive measures in positive HD patients, and finally directions to manage logistics and personnel are reported. These recommendations should be considered neither universal nor absolute. Instead, they require local adjustments based on geographic location, cultural and social environments, and level of available resources.