Thread by @renalpages

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I’ve been on call the last 4 days

Some reflections about #COVID-19 in renal patients ( this is based on my observations and is not clinical advice)

•in dialysis patients COVID isn’t always severe
•Many have mild symptoms – important to screen and isolate

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•UF on non-dialysis days really helps with symptomatic relief of SOB
• Best to keep lungs on the ‘crispy’ side- aids recovery
• Unilateral lung involvement common on CXR
• Be aware of AVF thrombosis

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•First swab often negative- if you think its COVID send a 2nd swab
•Sputum sampling yields better PCR results
•Cardiac injury common – remember to look for it – it aint all COVID
•Super added bacterial lung infection is common – start antibiotics early

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•AKI common in COVID – most don’t need dialysis –
•Coagulopathy is common in AKI caused by COVID
•Patients on ICHD are afraid – don’t ignore their fears – speaking to them allays fears
•Remind them no matter how ill they are they need to come in for HD –

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•For home patients – telephone consults and reassurance necessary
•Remember to stop CNI in transplant patients
•Transplant patients amazingly resilient

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•HD patients can be very sick – don’t give up – ITU not always an option but despite low BP most HD patients are still able to tolerate HD- so try it
•If very ill –speak to them about DNAR best done by a clinician who knows them rather than an unknown face from critical care

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•Having said that familiarity makes the decision difficult – if so ask ITU for second opinion/sense check
•Make time to call the family of the patients you admit
• Allow visitors if EOL ( but ask IPC first)

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•PD peritonitis can mimic COVID
•Dialysis patients can survive COVID
•remind them to self-isolate from others when home

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•Respect your nurses more than ever – PPE during HD isn’t for the faint-hearted
•Thank the dialysis nurses and the ward staff – they are scared too

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• look after your juniors - this is an uncertain time for them and many are working way above their SOP
• Look after yourself - its going to be a marathon not a sprint - rest when you can - you're no good on 0 battery power

END ( for now )