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Covid-19 Primary Care Resources


Chronic Kidney Disease



Maximising the safety of adults with chronic kidney disease during the pandemic

This information is sourced from NICEThink Kidneys, PHE and Kidney Care UK:

CKD and categorising risk

Vaccine effectiveness and CKD

  • The published studies are mainly non UK studies (ie with different vaccine schedules) and have been on haemodialysis patients and transplant patients
  • For dialysis patients, most international studies show around 4 of every 5 dialysis patients make antibody against the SARS-CoV-2 virus at around 4 weeks after the second dose. The amount of antibody is less than for healthy individuals of a similar age
  • Dialysis patients seem to take about 1-2 weeks longer than individuals of the same age to start making antibodies. After the antibodies are detectable, dialysis patients do not make as quite much as the general population
  • In the biggest single study of transplant patients, just over half developed antibodies after the second dose
  • Transplant patients take longer again to make antibodies, and we don’t know yet when their peak response is

Modifying usual care

  • The NICE Covid-19 rapid guideline on CKD advises GPs to modify usual care to reduce patient exposure to Covid-19 and make best use of resources
  • GPs should discuss the risks and benefits of changing treatment schedules with patients

Medicines

  • Advise patients to continue taking their medicines (including ACE inhibitors, ARBs, immunosuppressants and diuretics) as normal (unless advised to stop for a clinical indication)
  • This includes patients who have symptoms of Covid-19
  • Be aware that there is no evidence from clinical or epidemiological studies that ACE inhibitors or ARBs might worsen Covid-19
  • For patients with CKD and suspected or confirmed Covid-19, review the use of medicines, taking into account whether any have the potential to adversely affect renal function

Monitoring CKD

  • Reassess renal function in patients with CKD who have recovered from Covid 19. Base the urgency of reassessment on the patient’s GFR category, comorbidities and clinical circumstances
  • For patients who are stable on treatment, assess whether it is safe to reduce the frequency of routine blood and urine tests during the Covid 19 pandemic. Take into account any comorbidities and whether their CKD is progressive
  • Encourage self-monitoring and self-management (including blood pressure monitoring) for patients who are able to do this. Give them access to their medical data through information systems such as PatientView
  • Ensure that patients who are self-managing know when/how to seek help

Referrals to renal services

  • Delay referral if the clinical need is not urgent, for example, if the patient has mild to moderate proteinuria and a stable GFR (including patients with suspected inherited kidney disease)

Continue to refer patients for urgent outpatient appointments if there is a clinical need, for example:

  • Accelerated progression of CKD, defined as: a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months or a sustained decrease in GFR of 15 ml/min/1.73 m2 per year
  • Nephrotic syndrome or very severe proteinuria (urinary ACR more than 300 mg/mmol)
  • A new diagnosis of GFR category G5 (GFR less than 15ml/min/1.73m2)

Kidney Care UK have produced Covid-19 guidance for patients with kidney disease

Written by Dr Poppy Freeman