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.
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 email@example.com and provide: forename, surname, address, postcode and high-risk group (and helpful to also give CHI).
Fantastic leaflet giving information for health professionals working with kidney patients (June 2022).
PHS are promoting the following key messages:
- For kidney patients, getting fully vaccinated against COVID-19 is the best way to protect against serious disease, being admitted to hospital or dying as a result of COVID-19 infection.
- It’s important kidney patients have all the recommended doses of the COVID-19 vaccine, because they may get less protection from the vaccine than the wider population.
- Getting all the recommended doses of the COVID-19 vaccine helps increase the level of protection for kidney patients as they may not have generated a full immune response to the first two doses.
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 help patients in relation to the COVID-19 vaccine:
- Direct people to www.nhsinform.scot/covid19vaccine for up-to-date information about COVID-19 vaccination.
- Reassure your patients that community vaccination clinics will be safe and welcoming. Appointments can be made online at www.nhsinform/vaccinebooking or by calling the national vaccination helpline on 0800 030 8013. People can check their local Health Board’s website or social media for up-to-date local vaccination clinic information.
How to request ad hoc vaccination appointments: E-mail firstname.lastname@example.org and provide: name, CHI, contact telephone number.
Treatment of COVID-19
High-risk patients eligible for additional treatments can access these by phoning the local Covid team – see NHS Inform. The phone number for Lothian is 0300 790 6769.
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.
Almost all of the relevant guidance can be found here; much of it is specific for NHS Lothian.
- Intranet pages and guidance documents (only accessible within NHS Lothian)
- Anticipatory care planning (only accessible within NHS Lothian)
- Lothian & Borders COVID19 Haemodialysis Guidance
- Lothian & Borders COVID19 Information for Dialysis Patients
- Sotrovimab on dialysis
- Lothian “COVID Zone” induction pack
- National Infection Prevention Control Manual
- Health Protection Scotland guidance – Covid19 homepage
- Health Protection Scotland – guidance for health professionals in secondary care
- NHS Inform – information for health professionals
- NICE guidance on management of Covid-19
- NICE guidance on decisions around critical care
- BMA guidance on ethical issues
- Covid-19 Green book chapter (vaccination guidance)
- BMJ living guideline on drug therapies in Covid-19
- CMO Scotland letter on death certification (24th March 2020)
- Renal Association guidance for health professionals
- ODT guidance for health professionals
- Renal Association / BTS guidelines for management of transplant-recipients with Covid-19
- NICE guidelines on renal transplantation in Covid-19 pandemic
- NICE guidelines on AKI in Covid-19
- Covid-associated AKI ADQI consensus report
- National Inpatient Diabetes Covid-19 Response Group guideline on glycaemic control after dexamethasone
- RCOG guidelines on pregnancy
- Resus Council guidance on CPR
Education & further information
- BMJ Covid Hub
- NephJC pages – an ever-expanding resource with renal-specific information on Covid-19 and transplant, dialysis, AKI, ACEi / ARBs etc.
- RCPE weekly evening updates
- NHS Lothian Medical Education pages
- NHS Education for Scotland TURAS pages
- UoE / RCPE Critical Care course on FutureLearn
- online training for enrolling patients in the RECOVERY trial
- Internet Book of Critical Care – critical care textbook
- Coronavirus Tech Handbook – collaborative document with links to many other sources
- Wellcome timeline of developments in our understanding of Covid-19
Epidemiology and data visualisation
- Travelling Tabby Scotland Covid-19 tracker
- Our World In Data
- Information Is Beautiful
Core trials / papers
- OpenSAFELY: factors associated with mortality (large UK cohort)
- ISARIC WHO characterisation study (large UK cohort)
- ISARIC 4C mortality score: prediction of mortality in patients hospitalised with Covid-19
- QCOVID: prediction of Covid-19 mortality risk (large UK cohort)
- Scottish Renal Registry data on outcomes in patients on RRT or with a kidney transplant
- Outcomes in solid organ transplant recipients in England
- RECOVERY Dexamethasone arm
- WHO meta-analysis of glucocorticoids in Covid-19
- WHO SOLIDARITY: RCT of remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a
- BioNTechnPfizer RNA vaccine trial
- Oxford adenovirus vector vaccine trial
- REMAP-CAP IL-6 antagonist preprint
- RECOVERY Tocilizumab pre-print
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.