Impact of COVID-19 pandemic on CKD outpatient management

Patients with chronic disorders, like chronic kidney disease (CKD), are considered at greater risk of COVID-19 infection, with higher morbidity and mortality. To date, specific instructions have been developed for managing COVID-19 outbreaks for patients on haemodialysis and peritoneal dialysis, and with kidney transplants; however, the proper management of patients with non-dialysis CKD is still being evaluated. The rapid spread of COVID-19 and the consequent lockdown, required many changes in our CKD center organization to avoid unnecessary exposure of staff and patients to infection, while still continuing to provide care and support to our patients. Therefore, elective treatments and procedures, routine laboratory testing and non-urgent outpatient clinics were deferred, and patients were divided in 2 main priority groups: 1)Non urgent, deferrable patients, for whom we adopted telemedicine follow-up; 2)Urgent, undeferrable outpatients, for whom an effort has been made to arrange for specific appointment times for blood drawing and for ambulatory visits. Specific recommendations have been provided to our staff office to respond to patient questions about a possible COVID-19 exposure. Elective procedures, as kidney biopsies and access creation for dialysis, have been defereed in most cases, except for urgent patients. For patients receiving intravenous treatments, we organized home therapy services; new enrolment into clinical trials has been paused during the COVID-19 crisis, but CKD patients enrolled in therapeutic clinical trials should continue the study drug.