Patients with CKD in phase 2 of COVID-19 immunization programme

The National COVID-19 Immunisation Programme has announced “high-risk group with chronic diseases” is priority group 2 in Phase 2 and will be vaccinated in April-August 2021. [Available at: www.vaksincovid.gov.my/pdf/National_COVID-19_Immunisation_Programme.pdf Accessed on 26 February 2021]

The announcement is welcomed by the National Kidney Foundation (NKF), Malaysian Society of Nephrology (MSN) and Malaysian Society of Transplantation (MST) which earlier raised concerns related to the impact of COVID-19 on patients with chronic kidney disease (CKD) and the healthcare workers (HCWs) looking after them.

“We view with great concern the rising prevalence of COVID-19 in the country over the past few weeks. We are particularly concerned on the impact of COVID-19 infection in patients with CKD especially those with CKD stage 5 who are receiving treatment with dialysis or kidney transplantation. Experience worldwide have shown this group of patients are very vulnerable to serious complications of COVID-19 infection and there is significant mortality amongst those infected. Similarly, there is increased risk of HCWs attending to these patients acquiring this infection due to frequent encounters,” said Dato’ Dr Zaki Morad Mohd Zaher, chairman, NKF; Professor Dr Abdul Halim Abdul Gafor, president, MSN, and Dr Rosnawati Yahya, president, MST, in a joint press statement.

According to the statement, Malaysia has about 50,000 patients undergoing dialysis or have a functioning kidney transplant. These patients have impaired immunity either due to illness or medications, which puts them at risk of complications if they are infected with COVID-19. Also, most of these patients are undergoing haemodialysis in a confined space for long hours which is a risk for them and HCWs to be infected despite the stringent guidelines followed by all haemodialysis centres.

If a patient or HCW is tested positive for COVID-19, the financial impact is huge while the emotional strain is unmeasurable because the patient’s and HCW’s close contacts have to be tested and quarantined; the centre must be sanitized, and everyone at the centre must use full personal protection equipment (PPE). If specialized nurses must be quarantined, the haemodialysis centre’s capacity is reduced as the nurses are not readily replaceable.

NKF, MSN and MST thanked MOH’s nephrologists and their haemodialysis units for accepting most of the patients who had COVID-19 from the private and NGO haemodialysis centres. They added that the COVID-19 immunization programme will reduce the overcrowding in MOH’s haemodialysis centres and assist the private centres and NGO programmes return to some normalcy. They had earlier urged MOH to give priority to the following groups in the COVID-19 immunization programme:
·       Patients on haemodialysis and peritoneal dialysis
·       Patients with functioning kidney transplants
·       HCWs directly attending to haemodialysis and peritoneal dialysis patients
·       Family members of haemodialysis/peritoneal dialysis/kidney transplant patients
·       Patients with CKD stage 3-4 (predialysis).