Chronic Kidney Disease

This information is sourced from NICE, Think Kidneys, PHE and Kidney Care UK:

PLEASE NOTE: THIS IS NO LONGER RELEVANT AND IS NOT BEING UPDATED BUT HAS BEEN LEFT ON THE SITE FOR REFERENCE PURPOSES ONLY

CKD and categorising risk

Patients with renal disease are at increased risk from Covid-19
Patients who are having dialysis or who have severe (stage 5) long-term kidney disease or who have had a renal transplant are considered clinically extremely vulnerable to Covid-19
Patients with CKD did not previously need to shield unless they were on immunosuppressant medication
Clinically Extremely Vulnerable people in areas where the new variant is spreading fastest, are not advised to shield but should take precautions to protect themselves including working from home where possible. People should continue to follow this advice after 2 doses of vaccine

The published studies are mainly non UK studies (ie with different vaccine schedules) and have been on haemodialysis patients and transplant patients
For dialysis patients, most international studies show around 4 of every 5 dialysis patients make antibody against the SARS-CoV-2 virus at around 4 weeks after the second dose. The amount of antibody is less than for healthy individuals of a similar age
Dialysis patients seem to take about 1-2 weeks longer than individuals of the same age to start making antibodies. After the antibodies are detectable, dialysis patients do not make as quite much as the general population
In the biggest single study of transplant patients, just over half developed antibodies after the second dose
Transplant patients take longer again to make antibodies, and we don’t know yet when their peak response is

Modifying usual care

The NICE Covid-19 rapid guideline on CKD advises GPs to modify usual care to reduce patient exposure to Covid-19 and make best use of resources
GPs should discuss the risks and benefits of changing treatment schedules with patients

Medicines

Advise patients to continue taking their medicines (including ACE inhibitors, ARBs, immunosuppressants and diuretics) as normal (unless advised to stop for a clinical indication)
This includes patients who have symptoms of Covid-19
Be aware that there is no evidence from clinical or epidemiological studies that ACE inhibitors or ARBs might worsen Covid-19
For patients with CKD and suspected or confirmed Covid-19, review the use of medicines, taking into account whether any have the potential to adversely affect renal function

Monitoring CKD

Reassess renal function in patients with CKD who have recovered from Covid 19. Base the urgency of reassessment on the patient’s GFR category, comorbidities and clinical circumstances
For patients who are stable on treatment, assess whether it is safe to reduce the frequency of routine blood and urine tests during the Covid 19 pandemic. Take into account any comorbidities and whether their CKD is progressive
Encourage self-monitoring and self-management (including blood pressure monitoring) for patients who are able to do this. Give them access to their medical data through information systems such as PatientView
Ensure that patients who are self-managing know when/how to seek help

Referrals to renal services

Delay referral if the clinical need is not urgent, for example, if the patient has mild to moderate proteinuria and a stable GFR (including patients with suspected inherited kidney disease)

Continue to refer patients for urgent outpatient appointments if there is a clinical need, for example:

Accelerated progression of CKD, defined as: a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months or a sustained decrease in GFR of 15 ml/min/1.73 m2 per year
Nephrotic syndrome or very severe proteinuria (urinary ACR more than 300 mg/mmol)
A new diagnosis of GFR category G5 (GFR less than 15ml/min/1.73m2)

Written by Dr Poppy Freeman