COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.

In 26 patients, a linear relationship between ΔKt/V (equilibrated minus single pool) and dialysis efficiency K/V was noted (r = −0.72). To determine if such a relationship would be supported by formal urea kinetic analysis, t, K_d, and V were randomly varied in 1,400 simulations using both intracellular/extracellular and regional blood flow 2 pool variable volume models. In the intracellular/extracellular model, ΔKt/V was best correlated with K_d/K_c (r = −0.96), where K_c is the intercompartmental clearance. K_c was not correlated with V, which translated into a lack of correlation between ΔKt/V and V, and a better correlation between ΔKt/V and K_d than between ΔKt/V and K/V. In the regional blood flow model ΔKt/V was best correlated with K_d/Q_L (r = −0.99), where Q_L is the perfusion of the low flow compartment. Q_L was correlated with V because Q_L is a function of cardiac output, which varies with surface area and therefore with V. In the regional blood flow model, ΔKt/V did correlate with V (r = 0.49), and better with K/V (r = −0.76) than with K (r = −0.47), similar to the results in patients. The slope of ΔKt/V on K/V depended upon fQ_L (the fractional perfusion of the low flow compartment) and on cardiac index. At an fQ_L of 0.15 and a cardiac index of 2.85, the theoretical slope was similar to that seen in observational data: ΔKt/V = −0.6 × K/V + 0.03. The results show that the regional blood flow model predicts the observed relation between ΔKt/V and K/V, whereas the intracellular/extracellular model fails in this task unless one arbitrarily ties K_c to V.

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.