COVID-19

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Aims

The aim of this page is to provide links to reliable sources of information and to our local unit protocols. We have a separate page providing information about COVID-19 for patients with kidney disease.

 

High-risk groups

In Scotland, “shielding” is no longer advised and so this terminology should be avoided.  Preference now is to refer to “highest-risk group”.   It is important to keep an accurate list of this group (e.g. for management of local outbreaks / prioritisation of booster vaccination).  Guidance about / for this highest risk group is published by the Scottish Government.

How to add a patient to the “highest-risk list”:  E-mail covid.highrisk@nhslothian.scot.nhs.uk and provide: forename, surname, address, postcode and high-risk group (and helpful to also give CHI).

 

Vaccination

The Renal Association have released a briefing document on Covid-19 vaccination for individuals with CKD.  Vaccination is safe and effective in individuals with CKD.  The JCVI priority groups for Covid vaccination are given here.  A more up-to-date list of priority vaccination groups in Scotland is given here.

How to request ad hoc vaccination appointments:  E-mail loth.covidvaccenquiries@nhslothian.scot.nhs.uk and provide: name, CHI, contact telephone number.

 

Treatment of COVID-19

Treatments are now well-established (e.g. see NICE guidelines – link below).  Early anticipatory care planning is vital for ALL patients.  Complete NHS Lothian Treatment Escalation Plan (TEP) on Trak.  The ISARIC 4C score can be an adjunct in prognostication.  All patients should be given the opportunity to participate in RCTs (such as RECOVERY).

Many patients with kidney disease are eligible for treatment with neutralising monoclonal antibodies (nMABs): both in hospital and in the community.  Non-hospitalised patients will be prioritised if they meet the following criteria:

  • recipient of kidney transplant (including failed transplants within 12 months) who received B-cell depleting therapy within 12 months or were not vaccinated prior to transplantation or have an additional substantial risk factor
  • non-transplant patients who have received a comparable level of immuosuppression
  • CKD4 or 5 (eGFR < 30) even without prescribed immunosuppression

In NHS Lothian, non-dialysis patients eligible for these treatments will be identified and offered treatment via Public Health Scotland or enrolled in the PANORAMIC trial.  Dialysis patients eligible for IV Sotrovimab will receive this at the end of dialysis treatment, usually in the WGH facility (see unit protocol below).

Treatment in kidney disease

No major modification required to standard treatment.  RAS inhibitors (ACEi / ARBs) should be continued.

 

Information for patients

See our page on patient information about COVID-19 and the Kidney Care UK site.  Having CKD – particularly CKD4/5 – or an organ transplant increases the risk of death from Covid-19.  See OpenSAFELY, ISARIC and QCOVID studies (links below).  Talking about risk in the context of “normal” annual risk of death may be helpful (see David Spiegelhalter’s BMJ paper).  When talking about masks, see this great visual representation of how effective masks are at preventing droplet spread.

 

Unit Protocols

Almost all of the relevant guidance can be found here; much of it is specific for NHS Lothian.

 

External links

Core guidance

 

Society guidelines

 

Education & further information

 

Epidemiology and data visualisation

 

Core trials / papers

Observational:

Interventional:

 

Acknowledgements:  The author of this page was Rob Hunter. It was first published 17 March 2020. The date it was last modified is shown in the footer.

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