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Kidney Week

Abstract: PO0866

Developing a COVID-19 Screening Program for an Emergency-Only Dialysis Cohort Within a Large Public Safety-Net Hospital

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Bhatia, Ravi Dinesh, Emory University School of Medicine, Atlanta, Georgia, United States
  • Kasper, Lauren, Emory University School of Medicine, Atlanta, Georgia, United States
  • Johnson, Sarah Ann, Emory University School of Medicine, Atlanta, Georgia, United States
Background

As the prevalence of coronavirus disease 2019 (COVID-19) worsens, one patient population that warrants further inquiry are those receiving emergency-only hemodialysis (EoHD). This cohort specifically at Grady Health System (GHS) in Atlanta, consisting largely of undocumented immigrants, receives 1-3 times weekly hemodialysis (HD) via emergency departments due to legislative restrictions on Medicaid funding. GHS has one of the largest populations of EoHD patients in the nation. The cohort of 91 patients is 89% Hispanic with a mean age of 51. The majority of patients, 69%, reside in Fulton or DeKalb counties, the intended service region for GHS. The remaining patients reside in more distant counties, potentially increasing risk of transmission to a larger area. Prior to our screening program, 6 patients in the cohort had positive diagnostic tests and 4 of these patients required hospitalization (67%). Notably, 3 out of those 4 patients were admitted due to hypertensive emergency with pulmonary edema, so symptomatic COVID disease is debatable. Due to the frequency of hospital visits and requirement of isolation HD treatments if COVID+, a screening of the cohort was conducted. Our aim was to establish a baseline prevalence rate to direct an ongoing screening program in this vulnerable population.

Methods

Over 5 days, we conducted 84 COVID PCR screening tests via nasopharyngeal swab. One patient was excluded due to missed sessions. Patients were asked about symptoms prior to swabs. Swabs were obtained by a single operator in a consistent fashion. Data was collected and stratified by patient demographics.

Results

A total of 84 patients were screened for COVID. Notably, 3 asymptomatic patients had positive results, a rate of 3.6%, and 6 patients had positive diagnostic tests prior to screening, resulting in a rate of 9.9% positive COVID tests. 6 patients were DeKalb/Fulton residents (67%).

Conclusion

The risk of COVID-19 in EoHD patients is an issue that will require a coordinated effort to prevent the spread of disease. A collaboration between nephrology and infectious diseases has led to the implementation of a bimonthly screening program. Future directions include antibody screens and contact-tracing to understand more fully the spread of disease as well as elucidating the asymptomatic positive rate vs. actual disease prevalence.