Management Of Patients On Dialysis And With Kidney Transplant During SARS-COV-2 (COVID-19) Pandemic In Brescia, Italy

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease (COVID-19) is a major pandemic challenging health care systems around the world. The optimal management of COVID-19 infected patients is still unclear, although the consensus is moving towards the need of a biphasic approach. During the first phase of the disease (from onset of the symptoms up to 7-10 days) viral-induced effects are prominent with the opportunity to institute antiviral therapy. In the second inflammatory phase of the disease, immunosuppressive strategies (for example with glucocorticoids or anti-cytokines drugs)may be considered. This latter stage is characterized by the development of progressive lung involvement with increasing oxygen requirements and occasionally signs of the haemophagocitic syndrome. The management of the disease in patients with kidney disease is even more challenging, especially in those who are immunosuppressed or with severe comorbidities. Here we present the therapeutic approach employed in Brescia (Italy) for managing kidney transplant and hemodialysis patients with COVID-19. Furthermore, we provide some clinical and physiopathological background, as well as preliminary outcome data of our cohort, in order to better clarify the pathogenesis of the disease and clinical management.