SARS-COV-2 Screening in Dialysis Facilities: Building an Optimal Strategy to Protect High Risk Populations

Background: The purpose of this study was to offer SARS-CoV-2 screening tests at selected dialysis facilities to reduce transmission, detect early cases, and prevent serious illness among patients receiving dialysis. Patients undergoing dialysis face a higher risk of hospitalization and higher risk of death from COVID-19 compared with the general population. These patients also disproportionately represent racial and ethnic minority and economically disadvantaged groups. This study aimed to increase access to highly sensitive and specific SARS-CoV-2 testing in this medically vulnerable population.

Materials/Methods: This pragmatic cluster randomized study was conducted at the facility level to evaluate patient acceptability of two SARS-CoV-2 testing strategies offered at dialysis centers. The study compared anterior nares RT-PCR tests administered at a static frequency versus a dynamic frequency based on county-level COVID-19 transmission rates. A pilot phase was implemented at four dialysis facilities, followed by scale-up to 62 facilities within U.S. Renal Care. After three months of testing, outcomes were assessed at both the patient and facility levels.

Outcome/Impact: Primary outcomes included patient-level test acceptability, with secondary outcomes measuring facility-level deaths and hospitalizations. The study sought to identify a highly acceptable universal testing strategy for dialysis patients to enable early detection of infection and reduce serious COVID-19 complications within this high-risk and underserved population.