COVID-19 risk stratification – resources for clinicians

British Renal Society/Renal Association group to assess and explain stratified risk of  COVID-19 (coronavirus) in kidney patients

Updated: 28/8/2020

Aim: to provide information and guidance to the renal community on the risk of serious harm from COVID-19 as the initial period of shielding ends

Summary

Shielding measures for renal patients that started in March have been paused on 1 August in England, Northern Ireland, and Scotland. In Wales, shielding will be paused from 16 August.

Patients on the transplant waiting list, and within the first three months of a kidney transplant, are recommended to consult with their local kidney unit as exact details of local advice on the levels of self isolation recommended  may differ according to local prevalence.

More recent data, together with expert opinion, are being used to create a new risk stratification grid which can be held in shadow version. This includes quantification of risk for patients with kidney disease which can be used to provide thresholds for reintroduction of shielding during any second wave of COVID-19 (or local spikes) and to prioritise vaccination once a vaccine is available.

At time of writing the government has not agreed to continued additional support (including financial) for those who remain in the most vulnerable groups, including some patients with kidney disease. For example, no additional support has been agreed as yet for patients pre- and immediately post-new transplants, or for patients receiving dialysis treatment and who have additional risk factors through age, gender, ethnicity or co-morbidity and have known high mortality risk if they contract COVID-19.

The RA/BRS is continuing to lobby the government to request additional ongoing support for these most vulnerable groups and is emphasising the importance of recognising and understanding the very significant vulnerability of kidney renal patients at risk of COVID-19.

All data collected to date have been skewed by the effect of shielding. It is therefore imperative moving forward that despite falling cases, the renal community continues to collect data about COVID-19 infection and death rates after de-shielding in order to update advice and guidance.

This document was created by a multi-disciplinary working group of health professionals clinicians and patients with representatives from the British Renal Society, British Transplantation Society, Renal Association, Kidney Care UK, and National Kidney Federation in order to review the best literature and data available that could inform the assessment of risk in renal patients,  and in collaboration with patients to create resource to help patients understand that risk so that they are able to make decisions about how shielded they wish to be in the future.

The advice here applies to adult patients over 18 years of age. Separate guidance can be found for children here.

Given the evolving situation the document will be reviewed fortnightly for the next month and thereafter as the clinical picture changes.

We have created the following toolkit to help clinicians support patients following the pausing of shielding:

  Following a consultation period this has been updated on 28.8.20

  Infographics to help patients to assess risk

   Template letters to support health care professionals to inform employers about the risk to patients who are electing to return to work or are electing to continue to shield (to be used with the risk stratification grid). -At risk patients - At risk family members

   A leaflet to help clinicians in discussions of risk with patients during these times

   Links for patients to source social distancing lanyards and badges to allow them to identify themselves as at risk patients as they de-shield. - NKF lanyard - KCUK badge

  A link to the KCUK website question and answer page generated by KCUK with this group to try to address common questions from patients about de-shielding.

Up to date guidance on shielding can be found at:

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

https://gov.wales/guidance-shielding-and-protecting-people-defined-medical-grounds-extremely-vulnerable-coronavirus-0

https://www.gov.scot/publications/covid-shielding/

https://www.nidirect.gov.uk/articles/guidance-shielding-extremely-vulnerable-people

Guidelines

NICE accredited clinical practice guidelines 

Available here

22nd Annual Report

Analyses about care provided to patients at UK renal centres.

Read the report

UKRR AKI Report

A report on the nationwide collection of AKI warning test scores. 

Read the report