Background Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly afected. Methods Survey of the network of Nephrology centers using a simplifed 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results On April 9th 2020, all nephrology centers (n=454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14–2.39) with signifcant diferences according to treatment modality (p<0.001). The proportion of patients positive for SARS-CoV-2 was signifcantly higher in HD (3.55% [95% CI 3.34–3.76]) than PD (1.38% [95% CI 1.04–1.78] and Tx (0.86% [95% CI 0.75–0.98]) (p<0.001), with substantial heterogeneity across regions and along the latitude gradient (p<0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11–4.68], followed by the north-east (IR 2.06% [1.79–2.36]), the center (0.91% [0.75–1.09]), the main islands (0.67% [0.47–0.93]), and the south (0.59% [0.45–0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to difer substantially across regions, along geographical latitude, and by treatment modality.

Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology / Quintaliani, G; Reboldi, G; Di Napoli, Anteo; Nordio, Maurizio; Limido, Aurelio; Aucella, Filippo; Messa, Piergiorgio; Brunori, Giuliano. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - 33:4(2020), pp. 725-736. [10.1007/s40620-020-00794-1]

Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology

Brunori, Giuliano
2020-01-01

Abstract

Background Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly afected. Methods Survey of the network of Nephrology centers using a simplifed 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. Results On April 9th 2020, all nephrology centers (n=454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14–2.39) with signifcant diferences according to treatment modality (p<0.001). The proportion of patients positive for SARS-CoV-2 was signifcantly higher in HD (3.55% [95% CI 3.34–3.76]) than PD (1.38% [95% CI 1.04–1.78] and Tx (0.86% [95% CI 0.75–0.98]) (p<0.001), with substantial heterogeneity across regions and along the latitude gradient (p<0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11–4.68], followed by the north-east (IR 2.06% [1.79–2.36]), the center (0.91% [0.75–1.09]), the main islands (0.67% [0.47–0.93]), and the south (0.59% [0.45–0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. Conclusions A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to difer substantially across regions, along geographical latitude, and by treatment modality.
2020
4
Quintaliani, G; Reboldi, G; Di Napoli, Anteo; Nordio, Maurizio; Limido, Aurelio; Aucella, Filippo; Messa, Piergiorgio; Brunori, Giuliano
Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology / Quintaliani, G; Reboldi, G; Di Napoli, Anteo; Nordio, Maurizio; Limido, Aurelio; Aucella, Filippo; Messa, Piergiorgio; Brunori, Giuliano. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - 33:4(2020), pp. 725-736. [10.1007/s40620-020-00794-1]
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