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.
Unit Protocols – start here
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
- Lothian “COVID Zone” induction pack
Information for patients
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.
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”: Requests can be submitted by clinicians or by patients. Either way, e-mail email@example.com and provide: forename, surname, address, postcode and high-risk group (and helpful to also give CHI).
The Renal Association have released a briefing document on Covid-19 vaccination for individuals with CKD. Vaccination is thought to be 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 expedite vaccination in exceptional circumstances: See the guidance and referral form (excel sheet) on the NHS Lothian intranet. Complete and e-mail the referral form to the address given within.
Treatment of COVID-19
Treatments are now well-established (e.g. see NICE guidelines – link below).
All patients should be given the opportunity to participate in RCTs (such as RECOVERY).
Treatment in kidney disease
No major modification required to standard treatment. RAS inhibitors (ACEi / ARBs) should be continued.
- 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
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.