Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

Park, Hayne Cho; Lee, Young-Ki; Lee, Sang-Ho; Yoo, Kyung Don; Jeon, Hee Jung; Ryu, Dong-Ryeol; Kim, Seong Nam; Sohn, Seung Hwan; Chun, Rho Won; Choi, Kyu Bok

Patients with ESRD are vulnerable to infectious conditions due to multiple comorbidities and decreased immune function. As shown in the MERS outbreak in Saudi Arabia, hemodialysis patients can easily spread the disease through the narrow space between beds due to the passive nature of dialysis therapy. In the previous report, a total of 21 out of 23 confirmed cases were acquired by person-to-person transmission in a hemodialysis unit [3] . Aside from environmental factors, patients with chronic kidney disease showed a higher risk of in-hospital mortality compared to those without chronic kidney disease (odds ratio 5.84, 95% confidence interval 1.48-23.0, P = 0.012) [5] . Therefore, early detection of confirmed cases and appropriate infection control measures are very important to prevent further transmission of the disease in a dialysis facility. During the MERS outbreak in South Korea in 2015, a total of 186 confirmed patients with MERS-CoV infection were identified from 16 hospitals. Among them, only one dialysis patient was reported to be a confirmed patient with no further transmission or in-hospital mortality in the dialysis unit. This monumental record is due to the pre-emptive action taken by the Korean Society of Nephrology together with the KCDC to prevent viral transmission as well as unpaid care provided by volunteers and related medical corporations. In addition, the joint committee of the Korean Society of Nephrology and Korean Society of Dialysis Therapy took immediate steps to establish clinical recommendations and guidelines to confront current epidemics and ensure readiness for future events.