Kidney disease & COVID-19

Does kidney disease put me at a higher risk?

People with kidney disease and other severe chronic medical conditions are at higher risk for more severe illness.

People on dialysis can have weaker immune systems, making it harder to fight infections. However, it is important to know that kidney patients need to continue with their regularly scheduled dialysis treatments and to take necessary precautions as recommended by their healthcare team.

People with a kidney transplant need to take anti-rejection medicines (also known as immunosuppressive medicines). These medicines work by keeping the immune system less active, which can make it harder to fight infections. It is important to keep taking these medicines. It is also important to wash hands, maintain good hygiene and follow the recommendations from their healthcare team.

Are there special precautions that someone with kidney disease should take?

Older adults and people with kidney disease or other severe chronic medical conditions seem to be at higher risk for more serious COVID-19 illness. If you are at higher risk of getting very sick from COVID-19, you should:

  • Stock up on supplies
  • Take everyday precautions to keep space between yourself and others
  • When you go out in public, keep away from others who are sick, limit close contact
  • Wash your hands often
  • Avoid crowds as much as possible
  • During an outbreak in your area, stay home as much as possible.

Please remember that if you are on dialysis, you should not miss your treatments. Contact your clinic if you feel sick or have any questions or concerns.

If you have a kidney transplant, it is important to remember to keep taking your anti-rejection medicines, maintain good hygiene and follow the recommendations from your healthcare team. Contact your healthcare team with any questions or concerns.

You can learn more about how kidney patients can be prepared for COVID-19 with this NKF resource.

What about people with autoimmune diseases that can harm the kidneys?

With an autoimmune disease, the body’s own immune system attacks the body's own cells, tissues and organs. Many of these diseases, such as IgA and lupus, can also attack and harm the kidney.

People with an autoimmune disease may be prescribed certain immunosuppressive medicines by their healthcare professional (depending on the disease and other factors). These medicines work by keeping the immune system less active, which can make it harder for the body to fight infections.

Recommendations to reduce risk from COVID-19:

  • keep taking any medicine as prescribed
  • wash your hands
  • maintain good hygiene
  • follow recommendations from your healthcare team

You should contact your healthcare professional for any questions or concerns.

You can find information on general COVID-19 prevention at the Centers for Disease Control (CDC) website.

Should CKD patients wear masks in public?

It is best to stay home, unless you need to attend a dialysis treatment. If you must go out in public, ask your healthcare provider if it is necessary as a CKD patient to wear a face mask since each individual case is different.

The Center for Disease Control (CDC) recommends face masks for those who are infected with COVID-19, have symptoms of COVID-19, or taking care of someone with COVID-19.

The CDC also recommends wearing cloth face coverings to slow the spread of COVID-19 in areas where community-based transmission is significant. These homemade cloth face coverings are not masks and do not replace the President’s Coronavirus Guidelines.

Tips for using a mask include a snug but comfortable fit covering the bridge of the nose and the entire mouth. Also, be sure to be laundered the cloth mask after use each outdoor use, ideally without damage to the shape or structure of the mask. The CDC is recommending a cloth face cover like the t-shirt used in this video. The CDC also recommends coffee filters as an alternative. Use of any mask is in addition to practicing social distancing or at least 6 feet from others to limit coronavirus spread. All patients at high risk, such as immunosuppressed transplant recipients or people receiving dialysis should follow the directions of their clinicians regarding the type of face covering that should be used outside of a clinic setting.

When in public it is important to practice social distancing by staying 6 feet away from other people and to also avoid touching your face. Wash your hands immediately after you have been in public.

More information about face coverings on the CDC website.

What should I know about miracle cures and treatments?

" The FDA considers the sale and promotion of fraudulent COVID-19 products to be a threat to the public health."

Stephen H Hahn, MD, FDA Commissioner

Unfortunately, in times of uncertainty, there are people who look to prey upon those who are vulnerable. The US Food and Drug Administration (FDA) reports there are unscrupulous companies and individuals looking to fraudulently profit by scamming people who want to prevent and/or treat COVID-19.

Knowledge is power

The best way to avoid becoming a victim of fraud is to know the facts. According to the latest guidance from the CDC, there no vaccines or drugs approved to treat or prevent COVID-19. And, while there are investigational COVID-19 vaccines and treatments in development, these investigational products are still in the early stages of development and have not yet been fully tested for safety or effectiveness.

Beware of false promises

Products that claim to cure, mitigate, treat, or prevent disease, but are not proven safe and effective for those purposes, defraud consumers of money and can place consumers at risk for serious harm. Fraudulent COVID-19 products may come in many varieties, including dietary supplements, such as vitamins and minerals, foods (garlic), as well as questionable products purporting to be drugs, herbal remedies, immune boosters, medical devices, or vaccines. Using these products may lead to delays in getting proper diagnosis and treatment for COVID-19.

The FDA urges consumers and patients to talk to their healthcare providers and to follow the advice from federal public health agencies about how to prevent the spread and treatment options for people with COVID-19.

How can I protect myself if I need a blood test or other labs?

" Keep in mind that you may need a new “order” from your doctor if you use a new lab."

For routine blood draws or other kinds of labs, contact your healthcare provider to determine if the test can be postponed. If your doctor feels the test is necessary to do now, contact your lab to see if it can be done at home. Check if your lab is accepting urine samples dropped off at their site or sent through the mail. Sterile specimen cups can be purchased online or may be in stock at a local pharmacy.

If home testing is not an option, you should ask your lab, doctor, or transplant coordinator if there are any local labs that can provide in-home testing services. Not all health insurance plans cover lab visits at home, so you should contact your insurance provider to learn about your coverage.

Staying safe at the lab

If the test cannot be postponed or done in your home, you should know that medical facilities are taking precautions to keep you healthy. Hospitals, labs, doctors’ offices, and dialysis centers are evaluating patients and staff, such as checking temperatures and asking questions, to assess each person for active COVID-I9. If it is suspected that someone has the virus, then those people are kept isolated from all healthy people.

Prevention tips

It is also important that you take measures to help keep yourself safe and reduce the chance of getting COVID-19. Be sure to wear a mask when you go outside your home. Keep at least 6 feet distance between you and other people. Remember to wash your hands frequently and use hand sanitizer if there are no washing facilities. Avoid touching your eyes, mouth, and nose.

Be well prepared

Have extra supplies on hand, including surgical masks, hand sanitizer, and disposable gloves, so that if you come into contact with someone at a medical facility or if a technician comes to your home, you are both well protected. For in-home visits be sure to disinfect any surfaces that another person may have touched, such as doorknobs and countertops.

For National home testing programs click here:
CareDx
Natera

Ordering take-out with confidence

Many restaurants are now closed to enforce social distancing, but take-out is still available from many eateries. Here are some ideas for making ordering take-out easy even with your special kidney diet. Start by knowing your diet well and asking your dietitian for any tips or advice. If you have sodium, potassium, phosphorus, or protein restrictions, this information will help you make good decisions based on your specific dietary needs.

Plan ahead

Choose a restaurant where it will be easiest to select foods best suited for your diet. Restaurants where food is made to order are the best choice.

Making your selections

Look over the menu carefully. Ask for more details about items you do not know about. When you place your order explain that you are following a special diet. Make special requests about the way your food is prepared as follows:

Entrées:

  • Portions served in restaurants may be much larger than what you eat at home. When ordering take-out, estimate an amount close to what you normally have. (3 ounces of cooked meat, fish, or poultry is about the size of a deck of cards). Plan to have leftovers or split the meal with another person.
  • Grilled items are good choices.
  • Request that salt not be added when cooking.
  • Request that gravies or sauces be served in a separate container.
  • Avoid mixed dishes or casseroles. They are usually higher in sodium and phosphorus.
  • Remove the skin from poultry and any crusts from fried foods to decrease sodium content.
  • It is best NOT to add steak sauce, Worcestershire sauce, soy sauce, or hot sauce because of the high sodium content.
  • Lemon or lime juice and vinegar make good sauces and will bring out a lot of the natural flavor of foods. Black pepper will add zest to the food without making you thirsty.

Side dishes:

  • If you need to restrict potassium, choose starches and vegetables that are lower in potassium, such as rice, noodles and green beans.
  • If your meal does not include a good choice for your diet, request a substitute.
  • Ask that sauces be omitted or served in a separate container.

Stay safe

Ask the delivery person to leave the bag outside your door or be sure to keep your distance from them, especially if you need to pay them directly. If you have to pay them directly, consider wearing gloves. You can also wipe down the bag with a disinfectant wipe. Make sure food is well heated and reconsider the use of uncooked foods that aren't prepackaged. Of course, wash your hands before eating. Other tips on Safe Food Handling can be found at the FDA website.

What kind of foods should I have in my house?

If there is a virus outbreak in your area and you need to decrease your risk of getting sick, it’s important that you have food in your home. This will help reduce your risk of infection by allowing you to avoid crowded spaces like grocery stores and drug stores.

It's important for you to have shelf stable food choices to help you follow your kidney diet. Shelf stable means foods that last a long time without spoiling, such as canned foods. It’s important to prepare now by stocking up 2-3 weeks’ worth of healthy, kidney friendly foods, fresh water, and medicines. Check with your healthcare professional if you have any questions about your medications.

What are some kidney friendly low-sodium items (no potassium or phosphorus restriction)?

Includes all dialysis friendly foods as well as foods listed below.

Fruits (2-3 servings/day)

  • No sugar added canned fruits
  • Dried fruit
  • Fruit Juice

Vegetables (2-3 servings/day)

  • No salt added or low-sodium canned vegetables

Protein

  • Low-Sodium canned meat
  • Tuna
  • Salmon
  • Meat
  • Turkey
  • Chicken
  • Dried beans and peas
  • No sodium added or low-sodium canned beans
  • Shelf stable Tofu
  • Unsalted Nut butter
  • Unsalted Nuts and Seeds

Dairy (2-3 cups/day)

  • Dry Milk Solids
  • Evaporated milk
  • Shelf stable milk alternative (refrigeration required after opened)
  • Rice, soy, almond

Grain

  • Whole grain breads and pastas
  • White or brown rice
  • Unsalted crackers
  • Dry cereals: Low sodium
  • Cooked Cereals
  • Cream of wheat or rice
  • Grits
  • Rolled or steel cut oats

Fats

  • Unsalted butter or margarine
  • Low-sodium mayonnaise (single packets)
  • Salad or cooking oil

Sweets

  • Animal crackers
  • Chewing gum
  • Graham crackers
  • Hard candy
  • Jellybeans
  • Vanilla Wafers

Other

  • Low-sodium Soups and Broths
  • Honey
  • Jelly
  • Jam

Can COVID-19 cause kidney failure in otherwise healthy adults?

There have been recent reports of nonelderly adults infected with COVID-19 who have developed an acute kidney injury (AKI) — sudden loss of kidney function. These adults did not have underlying medical conditions. With proper treatment, including dialysis in severe cases, AKI can be reversible.

Acute kidney injury (AKI) and chronic kidney disease (CKD)

Acute kidney injury (AKI) is not the same as chronic kidney disease (CKD), which will eventually lead to chronic kidney failure (CKF). Neither CKD or CKF are reversible diseases. Detecting proteins and/or blood in urine labs is an early sign of kidney involvement in people with confirmed COVID-19.

AKI and COVID-19

Initial reports from Wuhan found approximately 3% to 9% of hospitalized patients with confirmed COVID-19 developed an AKI. Incidence rates have now increased to 15% of hospitalized patients and 20% and higher in ICU patients with many requiring dialysis treatments. AKI appears to be a marker of COVID-19 infection severity and the mortality rate is higher for these patients

Various COVID-19-related effects that are thought to contribute to AKI include kidney tubular injury (acute tubular necrosis) with septic shock, microinflammation, increased blood clotting, and probable direct infection of the kidney. Most patients with COVID-19-related AKI who recover continue to have low kidney function after discharge from the hospital.

Long term implications of AKI

It’s recommended that recovered COVID-19 patients who had an AKI should be seen regularly by a kidney doctor, because their risk of developing chronic kidney disease is higher than others. COVID-19 patients who did not develop an AKI, but who had blood and/or protein in their urine, should be monitored since they are at increased risk of developing chronic- and end-stage-kidney disease.

Key points for patients with kidney disease

COVID-19 is a new virus, and therefore research on it has only just begun. Some hypotheses — ideas based on very little evidence — have been made about the effects of certain drugs on COVID-19, but nothing has been proven. In fact, leading health organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have not recommended that patients stop any particular drug in order to decrease the chance of getting COVID-19 or to make it less severe. Some common drugs that have been highlighted in the news are discussed below.

Blood pressure medications called angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) should NOT be stopped, unless recommended by a healthcare professional. These drugs are key to controlling blood pressure in patients with kidney disease. Stopping them could lead to a heart attack, stroke, or decreased kidney function. Learn more from the American College of Cardiology.

Patients with kidney transplants should not stop taking their immunosuppressants or lower their dose, unless their healthcare team tells them to. Stopping your immunosuppressants will most likely lead to the loss of your donated kidney. Contact your transplant team for any questions or concerns. Follow precautions as recommended by the American Society for Transplant located here.

Patients with kidney disease are usually told to avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. In general, kidney experts recommend acetaminophen for pain relief and reducing fever. But if you’re told by your healthcare team to take an NSAID for a specific reason, then you shouldn’t stop taking it because of COVID-19. Always talk with your healthcare team before making any changes in the drugs you take. Find the WHO's statement here.

Will there be drug shortages?

Since people with kidney disease depend on medicine to stay healthy it is important to understand issues related to potential drug shortages due to COVID-19. It’s hard to know which drugs will be affected, but it’s best not to panic. Hoarding and stockpiling drugs will only cause drug shortages to happen faster. Call your healthcare provider if you have a problem getting any of your medicines.

  • Only take medicines that are prescribed by your healthcare provider
  • Do NOT change the medicines you’re taking without speaking to your healthcare provider

The Food and Drug Administration (FDA) keeps a close watch on the drug supply chain.

This includes the availability of active pharmaceutical ingredients (API) which are often made in other countries, and any other parts of the supply chain that may be impacted by COVID-19. You can find more information about drug shortages related to COVID-19 on the Food and Drug Administration (FDA) website.

Feeling stress and depression?

"It’s common for people who have been diagnosed with chronic kidney disease, patients on dialysis, and those who have received kidney transplants to feel sad and depressed. In fact, studies show that 20% to 40% of people with kidney failure may also have depression. While the risk of severe illness due to COVID-19 remains low in the general population, people who have a chronic illness or who are taking immunosuppressant drugs are at an increased risk of becoming very ill. These fears are real – and the worry and stress can lead to an even greater bout of depression. If you are feeling more depressed than usual, The Centers for Disease Control has some great tips for helping you to manage your stress and anxiety.

Coping strategies

If you are feeling more depressed than usual, The Centers for Disease Control has some great tips for helping you to manage your stress and anxiety.

It is true -- the coming days are going to be unlike any we’ve ever had to face before – however, there are ways to help manage stress and depression and to help you cope when you feel sad and overwhelmed.

For more information

What should I know about shelf stable foods?

It’s important to keep shelf stable foods on hand to avoid getting sick if an outbreak happens in your area.

Reminders:

  • Throw away cans that are opened, dented, or past their expiration date to avoid food poisoning.
  • Avoid using salt (and salt substitutes if you have a potassium restriction)
  • Keep distilled water on hand (bottles or jugs).

What about other underlying medical conditions?

There are other underlying medical conditions that people may have in addition to having undergone a kidney transplant recipient or dialysis treatment.

Some of these conditions are:

  • Chronic lung disease or moderate-to-severe asthma
  • Serious heart conditions
  • Immunocompromised due to cancer treatment, smoking, bone marrow transplantation, immune deficiencies, HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
  • Severe obesity (body mass index [BMI] of 40 or higher)
  • Diabetes
  • Liver disease

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