Transmission of COVID-19 Virus Among Patients and Staff in Dialysis Centers

Patients on dialysis are at risk for several infectious diseases, since they have reduced
immunological and have to regularly attend dialysis centres from once to thrice a week
depending on their residual renal function even if a pandemic is going on.

Dialysis patients and healthcare professionals of dialysis centres can become infected one
with the other.

The incident risk of COVID-19 in dialysis centres is still unknown. Given the challenges of
an early diagnosis of COVID-19, the likely transmission with outbreaks, the possibility of
reciprocal transmission of the infection among patients and healthcare professionals, the
frequent clinical severity of COVID-19 in dialysis patients because of the coexistence of
several comorbidities, CONTACT TRACING could be an effective and efficient tool to contrast
COVID-19 spreading in dialysis centres. This modality keeps trace of the contacts the new
COVID-19 case have had and allow the identification of other possible cases in that outbreak

Contact tracing is the key tool to detect and trace COVID-19 cases among patients and health
care professionals, i.e. the space-time mapping of the contacts among these two categories:

1. Daily for healthcare professionals

2. At every dialysis session for haemodialysis patients

3. At every hospital visit for patients on peritoneal dialysis

Maximum follow will be up to 12 months excepting in those patients who develop a
COVID-19-related clinically significant event:

1. Diagnosis of symptomatic COVID-19 with or without hospitalisation

2. Respiratory insufficiency with the need of CPAP or mechanical ventilation

3. Death associated or related to COVID-19

In the participating centres, the enrolment of patients and healthcare professionals will be
prospective, progressive and competitive till the number of cases of COVD-19 will reach 200
subjects. If study participation will be 10% and COVID-19 will be taken by 4% of the patients
with no prior exposure to COVID-19, we can estimate to enrol 5000 subjects (dialysis patients
and healthcare professionals) over a period of 12 months in 50-150 centres. The length of the
enrolment period of 6-12 months will depend also on future evolution of the pandemic in the
Italian regions that have not been massively hit by the infection.

Study data will be stored on a web-database, which will be created on purpose. Privacy
protection of patients and health care professionals will be pursued and granted by anonymous
data collection.

Given the longitudinal and prospective design of the study, Kaplan-Meier curves will be used
to describe the incidence of COVID-19 infection and the survival of dialysis patients and
their healthcare professionals.

Cox multivariate analysis will be used to:

1. Estimate the incidence, morbidity and mortality of COVID-19 in the two categories

2. Estimate predictors and/or confounders associated with the incidence of the three study
outcomes (infection, morbidity and mortality)