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UK Nephrology History: Coronavirus

Matt Graham-Brown and contributors


The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been (and continues to be) one of the greatest challenges to health and healthcare delivery internationally. First identified in Wuhan, China the spread of the disease is well documented and the World Health Organisation declared the disease a public health emergency of international concern in January 2020 and declared the disease a pandemic in March 2020. The first documented death from COVID-19 in the UK was in January 2020 and the ‘first wave ‘ of cases in the UK was (at the time) one of the largest outbreaks.

Coronavirus, immediately, posed a series of unique problems to patients with kidney disease. The immediate re-organisation of services (based on extremely limited data) was undertaken with the aim of protecting as many patients as possible from the potentially devastating consequences of contracting the disease and maintaining life-sustaining services as safely as possible. Finding the balance between these two objectives was difficult and they were often in conflict, and while individual renal units felt their own ways through many of these difficulties there was a tremendous, Nationally cohesive, effort to share practice, experience and (as it was gained) expertise. This effort was led by the newly formed UK Kidney Association (UKKA), speer-headed by the leadership of Paul Cockwell, Sharlene Greenwood, Katie Vinen, Claire Sharpe, Graham Lipkin and many others. A dedicated section of the UKKA website was developed to host relevant documents, guidelines and links to trusted external resources and regular communications were planned and delivered to upskill clinical teams as data emerged to inform practice. Zoom meetings and webinars, such a foreign concept just months before, became weekly staple. The UK Renal Registry, under the leadership of James Medcalf and Dorothea Niche, worked with units to capture and report cases in prevalent renal populations and case fatalities to describe the patterns of disease for patients with kidney disease across England, Wales and Northern Ireland. Professional organisations worked closely with major patient charities (Kidney Care UK and the National Kidney Federation) to ensure patient-facing documents and communications were consistent with the most recent advise, in the early days with a particular emphasis on ‘shielding advise’, how to access the support that was required and ensuring patients who were identified as CEV had been identified as such for all available support.

For dialysis patients the need to continue attend for life-sustaining therapy was clear, but it seemed likely that they would be more likely to develop a severe manifestation of the disease (a fear that was unequivocally proven to be correct Williamson 2020). For transplantation services the issues for the prevalent transplant population and acute transplant programs were also clear. Unlike dialysis patients though, prevalent transplant populations (and patients with CKD on immunomodulatory therapy) were able to shield along with other patients deemed ‘clinically extremely vulnerable’ (CEV).

The challenges that faced the UK renal community in the first 100 days of the pandemic have been well documented by John Feehally.

RA & coronavirus 2020- John Feehally FINAL.


The remainder of this article will discuss

  • How units came out of the first wave
  • The ongoing challenges to the care for dialysis patients
  • The disruption to acute transplantation
  • The ongoing challenges for prevalent transplant patients
  • The support given to intensive care units
  • The rollout of the vaccination program
  • The clinical science that informed practice
  • The clinical studies that were developed and delivered

How units came out of the first wave




Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, Curtis HJ, Mehrkar A, Evans D, Inglesby P, Cockburn J, McDonald HI, MacKenna B, Tomlinson L, Douglas IJ, Rentsch CT, Mathur R, Wong AYS, Grieve R, Harrison D, Forbes H, Schultze A, Croker R, Parry J, Hester F, Harper S, Perera R, Evans SJW, Smeeth L, Goldacre B. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430-436. doi: 10.1038/s41586-020-2521-4. Epub 2020 Jul 8. PMID: 32640463; PMCID: PMC7611074.




Last Updated on June 27, 2022 by Matt Graham-Brown