Home hemodialysis during the COVID-19 epidemic: comment on the French experience from the viewpoint of a French home hem
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EDITORIAL
Home hemodialysis during the COVID‑19 epidemic: comment on the French experience from the viewpoint of a French home hemodialysis care network Pierre‑Antoine Michel1 · Giorgina Barbara Piccoli2,3 · Cécile Couchoud4 · Hafedh Fessi1
© Italian Society of Nephrology 2020
Keywords SARS-CoV-2 · Home hemodialysis · France · Pandemic · COVID-19 A recent paper in Kidney International on the French experience with COVID-19 in dialysis patients states that between March 16 and May 4, 2020, of the 1621 infected patients listed in the REIN registry, 344 patients died, a confirmation of the high death toll among dialysis patients during the COVID-19 epidemic [1]. In this nationwide report, the prevalence of patients with COVID-19 varied between regions from less than 1% to over 10%. The incidence of the disease was higher in males, and in patients with diabetes and other comorbidities, while being on dialysis at home was associated with a lower rate of infection. In fact, during the SARS-CoV-2 pandemic, numerous studies showed that end-stage kidney disease (ESKD) is a major risk factor for developing severe COVID-19 [2, 3]. Acknowledging this grim prognosis has been a stimulus for reconsidering dialysis policy from a different point of view [1, 3, 4]. Home dialysis has been advocated as a safer option in times of epidemic and, among others, the French health care authorities strongly supported the development of home-based techniques in their documents which * Hafedh Fessi [email protected] Pierre‑Antoine Michel pierre‑[email protected] Cécile Couchoud [email protected] 1
Department of Nephrology and Dialysis, Hôpital TENON, Assistance Publique - Hôpitaux de Paris, Paris, France
2
Service of Nephrology, Centre Hospitalier LE MANS, Le Mans, France
3
Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
4
Agence de La Biomedecine, Paris, France
appeared in response to the COVID-19 epidemic [5, 6]. Potential drawbacks were also underlined, as were patients’ need to have frequent contacts with a dialysis center and to avoid being isolated. Home hemodialysis is still a Cinderella in Europe: while daily hemodialysis is considered to be one of the best renal replacement treatments, combining higher survival and a good quality of life, its penetration is limited. In France this technique has undergone a relatively rapid diffusion in the last 5 years. According to the data from the French Biomedicine Agency, during the peak period of the epidemic, between March 1 and June 15, 2020, only 7 of the 423 patients on home hemodialysis in France were diagnosed with COVID-19; the incidence is similar to that observed in patients treated with peritoneal dialysis (1.8%). Even considering the different distribution of home dialysis in France (Fig. 1), the recorded incidence is significantly lower than that observed in patients on in-center hemodialysis (1856 COVID out of 48,840 patients, 3.8%; p = 0.02) [7]. Interestingly, the virus diffusion was the highest in the reg
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