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Journal of the American Society of Nephrology

Comparative Analysis of SARS-CoV-2 Reproduction Rates in the Dialysis and General Populations.

Alhaji Cherif, Joanna L. Willetts, Len Usvyat, Yuedong Wang, Peter Kotanko

Chronic hemodialysis is a life-sustaining therapy, delivered mostly thrice weekly in dialysis clinics. For patients on dialysis who appear to have a heightened likelihood of severe infection or death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), travel to these facilities and proximity to fellow patients and health care providers during hemodialysis may pose an increased risk for SARS-CoV-2 infection. To prevent contagion, dialysis providers have implemented several interventions. Our goal was to better understand the dynamics of SARS-CoV-2 spread among patients on hemodialysis compared with the general population in the United States.

We used aggregated daily counts of confirmed coronavirus disease 2019 (COVID-19) cases for the general population in the United States1 and from Fresenius Medical Care North America, a large dialysis provider in the country, from March 1 to July 29, 2020. Following screenings in dialysis units, patients showing any relevant signs and symptoms or who had exposure to an infected person underwent nasopharyngeal or oropharyngeal swabs for RT-PCR testing for SARS-CoV-2. All patients included in the study were receiving in-center hemodialysis; patient characteristics are shown in Table 1. The time-varying reproduction number Rt, which represents the expected number of secondary cases arising from each new infectious individual at a particular time, was calculated using the method of Thompson et al.2 Rt is estimated from daily cases and an uncertain serial interval with a mean of 4.7 days (SD of 2.9 days) and a 14-day moving average.

About the Contributors

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as Vice Chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked 1982-89 at the Department of Physiology and the University Clinic of Internal Medicine, Innsbruck, Austria...

Alhaji Cherif, D. Phil.

Senior Mathematician

Alhaji Cherif, D.Phil., is Senior Mathematician at the RRI with over 10 years of multi- and transdisciplinary research experiences in nanotechnology (microfluidics), adaptive complex systems, and applied mathematical sciences and its application in life, physical and social sciences. He leads the mathematical modeling efforts relevant to pathophysiological mechanisms in dialysis patients, particularly, acid-base disturbance, bone and mineral disease, cardiovascular calcification and anemia...