COVID-19 NICE Guidance - patients with chronic kidney disease

The purpose of this guideline is to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic.

1. Communicating with patients and minimising risk

• Communicate with patients, their families and carers and support their mental wellbeing to help alleviate any anxiety they may have about COVID-19. Signpost to sources of information (such as Kidney Care UK)
• Some patients will have received a letter telling them they are at high risk of severe illness from COVID-19, support them to follow UK Government guidance
• Minimise face-to-face contact
• Inform patients that they should contact the NHS 111 online coronavirus service if they think they have COVID-19, they should also contact their renal team
• If patients need to attend face-to-face appointments or require blood tests, inform them how they can reduce the risk
• Use local services for blood tests where possible
• Minimise times in waiting areas

2. Patients with known or suspected cases of COVID-19

• When patients with known or suspected COVID-19 have been identified follow appropriate UK Government guidance
• If COVID-19 is later diagnosed in a patient not isolated from admission or presentation, follow appropriate UK Government guidance
• If a patient not previously known or suspected to have COVID-19 shows symptoms at presentation, follow appropriate UK Government guidance

3. Managing chronic kidney disease

• Think about how to modify usual care to reduce patient exposure to COVID-19
• Modify individual patient’s treatment plans as required
• Discuss the risks and benefits of changing treatment schedules or interrupting treatment with patients
• Advise patients to continue taking their medicines
• Reassess renal function in patients with CKD who have recovered from COVID-19
• For patients who are stable on treatment, assess whether it is safe to reduce the frequency of routine blood and tests during the COVID-19 pandemic
• Encourage self-monitoring and self-management for patients who are able to do this and ensure they know when they should seek help and who to contact

4. Specialist services

• To minimise risk from COVID-19, delay referral if the clinical need is not urgent
• Continue to refer patients for urgent outpatient appointments if there is a clinical need
• Contact the renal team by telephone or virtually if there is uncertainty about the need for an urgent outpatient referral
• To minimise risk from COVID-19 delay referral for a renal ultrasound if the result is unlikely to change management immediately
• Continue to refer patients for a renal ultrasound if the result might immediately change management
• When deciding whether to refer a patient for hospital admission, discuss with the admitting clinician

5. Advanced chronic kidney disease

• For patients who will be starting dialysis, continue to plan and carry out procedures to create vascular and peritoneal access
• Think about whether it is safe to delay starting dialysis during COVID-19 pandemic
• Continue to refer patients for transplantation if suitable
• Ensure all patients with advanced CKD have had the opportunity to participate in advance care planning