Latest information on Covid-19 for kidney patients

13 December 2021

There continues to be uncertainty around the new Omicron COVID-19 variant, but the spread of the variant is increasing rapidly throughout the UK and will soon become the dominant variant.

Latest information from an OpenSAFELY analysis using data from NHS England, compared different groups of people who have had two vaccinations. The data confirmed that kidney patients are at substantially increased risk of hospitalisation or death from COVID-19 compared to other groups in the general population. This includes those with chronic kidney disease stage 4 onwards, those who are on dialysis and those who are immunosuppressed.

Keeping up to date with your vaccinations is critical, but that does not offer complete protection, particularly against the Omicron variant. Because many kidney patients are at higher risk than those in the general population, additional precautions are critical.

Ways to stay safe

Get fully vaccinated for COVID-19 and flu, according to the schedule recommended for your circumstances, and make sure everyone in your household does the same. This is the best way to protect yourself and if you do get infected, you are much less likely to develop serious disease, be admitted to hospital or die than if you are unvaccinated. For more information about the correct vaccination schedule for you, please see our separate factsheet.

When your booster or your third primary dose and the following fourth dose booster (for immunosuppressed patients) is due, push for this to happen as soon as possible. This advice is the same for those waiting for a transplant or if you have received a transplant. If you know someone who has chronic kidney disease who is not yet fully vaccinated, encourage them to follow all the guidance on how to stay safe and to consider getting fully vaccinated in the light of the latest evidence.

Be extra vigilant. This is highly recommended over the next couple of weeks with so much uncertainty around the new Omicron variant and with an increased number of social gatherings over the festive period.

Follow the hands, face and space principles. Continue to wear a mask and encourage those around you to do the same. Socialise at quieter times of the day and meet in well ventilated areas or where possible outdoors. Avoid crowds, try to maintain social distancing and work from home if you can. Wash your hands regularly and disinfect surfaces you touch frequently.

If you have any concerns, then please talk to your kidney team or GP.

Treatment options available for kidney patients with Covid-19

On 8 December the Government announced two new treatments to be offered to clinically vulnerable people with Covid-19 within 72 hours of testing positive and with the aim of preventing the need for hospital admission.  However, with the increasing number of COVID-19 cases due to omicron, the advice has changed on 16 December.

If you suspect you have Covid-19 and have symptoms, you should have a PCR test as soon as possible, to ensure you are eligible for the treatments.If you are eligible for community treatment, you should receive a letter from the Government around the 18–20 December explaining how it works. You will be sent a priority PCR test to keep at home. If you have a positive PCR result from the 16 December, you should be contacted by an NHS Covid Medicines Delivery Unit (CMDU) who will arrange your treatment.

Antiviral treatment (Molnupiravir)

Molnupiravir is a new antiviral medicine. It should be available from 16 December to anyone who fits the criteria for Covid-19 treatment above but is not suitable for treatment with Ronapreve. It is possible that Ronapreve may not be effective against the Omicron variant in which case molnupiravir would be given instead.

Molnupiravir is given as a five-day course of tablets which will be delivered to your home, provided that the course can be started within five days of the onset of symptoms. It is thought that molnupiravir is safe for kidney patients, but more research is urgently needed, especially for those with a very low eGFR.

If you’re not eligible for molnupiravir under this scheme, then you may be eligible to participate in the PANORAMIC study (see below).

Monoclonal antibody treatment

When available these will be prioritised for the patients who are in the community, who test positive for COVID-19 and are considered at most risk of needing hospitalisation if not treated. Neutralising monoclonal antibodies (nMABs) give your body the Covid-19 antibodies it needs to fight the disease.  The antibodies will stick to the surface of the virus and stop Covid-19 from getting inside your cells, preventing you becoming seriously ill.

The advice on nMABs has changed from the 16 December because the currently available nMAB - Ronapreve, is unlikely to work against the omicron variant. Therefore, the nMAB which will be offered is Sotrovimab which is much more likely to be effective. However, it is in very short supply and unlikely to be available before January 2022. In the meantime, the focus will be on ensuring you get the oral antiviral treatment. When the Sotrovimab is available, you will be invited to the CMDU (usually in a hospital) to receive the treatment which is given through a drip in your arm or by several injections under the skin.  You will then be monitored at home.

This is the list of those with kidney disease considered to be at highest risk and eligible for community anti-viral treatment:

Renal transplant recipients (including those with failed transplants within the past 12 months,) particularly those who:
Received B cell depleting therapy within the past 12 months (including alemtuzumab, rituximab [anti-CD20], anti-thymocyte globulin)

Have an additional substantial risk factor which would in isolation make them eligible for nMABs or oral antivirals

Have not been vaccinated prior to transplantation

Non-transplant patients who have received a comparable level of immunosuppression
Patients with chronic kidney stage 4 or 5 (an eGFR less than 30 ml/min/1.73m2) (without immunosuppression), including dialysis patients.

If you feel you may be eligible for treatments (after 16 December) but haven’t been contacted, then contact your kidney team or GP.

Research studies you can get involved in

There are several studies taking place in the UK to help prevent Covid-19, to understand more about the latest Omicron variant and vaccine efficacy for kidney patients.

The PROTECT-V trial

The PROTECT-V trial, is a clinical trial to find out if the drug niclosamide, given as a nasal spray, can prevent Covid-19 infection in vulnerable, high-risk kidney patients and reduce the number of people who become seriously ill or die from it. Two further treatments will also shortly be added to the trial. The Kidney Charities Together will provide more information of how you can be part of these trials when this is available.

The PROTECT-V trial is funded by Kidney Research UK, LifeArc, the Addenbrooke’s Charitable Trust, and UNION therapeutics,

The MELODY study

The MELODY study is a new national study, to investigate how well third doses of COVID-19 vaccine protect immunocompromised patients and identify those who might still be at risk. This study is actively recruiting new patients and kidney transplant recipients are eligible to take part. To find out more and sign up please follow this link.

The Melody Study is funded by the Medical Research Council, Kidney Research UK, Blood Cancer UK, the Cystic Fibrosis Trust and Vasculitis UK

PANORAMIC

A national study called PANORAMIC, run by the University of Oxford, has just launched. Over 50s and people with underlying health conditions, including patients with chronic kidney disease or a transplant, who have tested positive for Covid-19 can now sign up for the trial. The people in the study will either be given standard treatments for Covid-19 or the same standard treatments, plus the antiviral molnupiravir (described above). The selection will be random and means there is only a 1 in 2 chance of being given the treatment. To find out more please follow this link.