Available via license: CC BY-NC-SA 4.0
Content may be subject to copyright.
197© 2022 Indian Journal of Nephrology | Published by Wolters Kluwer - Medknow
Introduction
The ongoing coronavirus disease 2019
(COVID-19) pandemic caused by the
severe acute respiratory coronavirus
2 (SARS-COV-2) infection has aected all
populations. Several global and national
agencies have created virtual dashboards
for reporting country-/city-specic data of
COVID-19-infected patients. The outcomes
of COVID-19 disproportionately aect
vulnerable populations such as the elderly,
obese, diabetic, and immunocompromised
people. Patients with end-stage kidney
disease (ESKD) are also at a higher risk for
infection and mortality.[1] These patients are
exposed to each other at dialysis facilities
with limited social distancing. Managing
maintenance hemodialysis (MHD) patients,
Access this article online
Website: www.indianjnephrol.org
DOI: 10.4103/ijn.IJN_48_21
Quick Response Code:
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused signicant global
disruption, especially for chronic care like hemodialysis treatments. Approximately 10,000 end-stage
kidney disease (ESKD) patients are receiving maintenance hemodialysis (MHD) at 174 dialysis
centers in Greater Mumbai. Because of the fear of transmission of infection and inability to isolate
patients in dialysis centers, chronic hemodialysis care was disrupted for COVID-19-infected patients.
Hence, we embarked on a citywide initiative to ensure uninterrupted dialysis for these patients.
Materials and Methods: The Municipal Corporation of Greater Mumbai (MCGM) designated
23 hemodialysis facilities as COVID-positive centers, two as COVID-suspect centers, and the rest
continued as COVID-negative centers to avoid transmission of infection and continuation of chronic
hemodialysis treatment. Nephrologists and engineers of the city developed a web-based-portal so
that information about the availability of dialysis slots for COVID-infected patients was easily
available in real time to all those providing care to chronic hemodialysis patients. Results: The
portal became operational on May 20, 2020, and as of December 31, 2020, has enrolled 1,418
COVID-positive ESKD patients. This initiative has helped 97% of enrolled COVID-infected ESKD
patients to secure a dialysis slot within 48 hours. The portal also tracked outcomes and as of
December 31, 2020, 370 (27%) patients died, 960 patients recovered, and 88 patients still had an
active infection. Conclusions: The portal aided the timely and smooth transfer of COVID-19-positive
ESKD patients to designated facilities, thus averting mortality arising from delayed or denied
dialysis. Additionally, the portal also documented the natural history of the COVID-19 pandemic
in the city and provided information on the overall incidence and outcomes. This aided the city
administration in the projected resource needs to handle the pandemic.
Keywords: COVID‑19, dashboard, end‑stage kidney disease (ESKD), hemodialysis, Mumbai,
Project Victory, web‑based portal
A Unied Citywide Dashboard for Allocation and Scheduling Dialysis for
COVID-19 Patients on Maintenance Hemodialysis
Original Article
Viswanath Billa1,2,
Santosh Noronha3,
Shrirang Bichu1,2,
Jatin Kothari2,4,
Rajesh Kumar2,5,
Kalpana Mehta6,
Tukaram Jamale7,
Nikhil Bhasin8,
Sayali Thakare7,
Smriti Sinha6,
Geeta Sheth9,
Narayan Rangaraj3,
Venugopal Pai3,
Amaldev Venugopal3,
Akshay Toraskar3,
Zaheer Virani10,
Mayuri Trivedi11,
Divya Bajpai7,
Shrikant Khot2,
Rasika Sirsat4,
Alan Almeida4,
Niwrutti Hase12,
Sundaram13,
Hariharan13,
Swapnil Hiremath14,
Iqbal Singh
Chahal15 on behalf
of the ‘Project
Victory’ consortium
The Project Victory Consortium
1Division of Nephrology,
Bombay Hospital, Mumbai,
Maharashtra, 2Apex Kidney
How to cite this article: Billa V, Noronha S, Bichu S,
Kothari J, Kumar R, Mehta K, et al. A unied citywide
dashboard for allocation and scheduling dialysis for
COVID-19 patients on maintenance hemodialysis.
Indian J Nephrol 2022;31:197-205.
therefore, remains a challenge due to the
risk of cross-infection and the inability
to isolate the infected patients. There is
also an additional risk of death arising
from missed dialysis due to inaccessible
COVID-19-designated hemodialysis
facilities.
India has 10.2 million conrmed cases of
COVID-19 as of end of December 2020,
with approximately 149,000 deaths. The
city of Mumbai recorded 293,436 conrmed
cases with 11,116 deaths on this date.[2]
Mumbai is the sixth most populous city in
the world with about 20 million inhabitants
spread over 233 square miles (population
density 73,000/square mile).[3] There are
174 hemodialysis facilities in Mumbai
catering to about 10,000 estimated ESKD
patients. Dialysis facilities in Mumbai
operate on dierent models, including
Received: 03-02-2021
Revised: 28-03-2021
Accepted: 03-08-2021
Published: 05-01-2022
This is an open access journal, and arcles are
distributed under the terms of the Creave Commons
Aribuon‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and
the new creaons are licensed under the idencal terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
198 Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022
charitable trusts, government, municipal, and for-prot
facilities. There is a wide disparity in the economic,
educational, and social class of patients who are treated at
these facilities. In the spring of 2020, the entire nephrology
community of this metropolis was faced with twin
problems – the high mortality associated with COVID-19
infection and the inability to manage the dialysis needs
of an infected patient at the existing dialysis centers.
The national lockdown in India initially resulted in the
shutting down of some hospitals and lack of clear guidance
to balance infection containment while maintaining
life-saving treatments such as dialysis.[4] This was the
stimulus to develop a solution to meet this unprecedented
challenge. Hence, the local public health authority, the
Municipal Corporation of Greater Mumbai (MCGM),
intervened and designated certain dialysis facilities,
strategically distributed across the city to treat only the
COVID-positive/-suspect patients [Figure 1a]. But the onus
of nding a suitable dialysis slot fell on the patients and
their primary nephrologist. However, lack of information
to direct a patient to an available slot at a specic facility
caused widespread anxiety and led to chaos. Despite
the mixed and fragmented model of dialysis services in
Mumbai, the Nephrology community quickly responded by
developing and deploying a strategic citywide dashboard
with a focus on providing hemodialysis in a timely fashion
to all COVID-19-infected ESKD patients across the city.
[Appendix] We report on how this was developed and
implemented with clinical outcomes.
Materials and Methods
Development of portal and dashboard
A real-time web-based portal was developed to oer
COVID-19-infected ESKD patients seamless and timely
access to a COVID-19 (positive/suspect) dialysis facility
within the city. This involved building an information
technology (IT) framework that tracked real-time
information on ESKD patients who tested positive.
The framework was deployed in the following stages.
Planning Stage: This coordinated eort was named “Project
Victory.” The MCGM rst designated 23 dialysis facilities as
dedicated COVID-19 positive centers (11 public centers and
12 private centers), two as COVID-19 suspect centers (one
public and one private), and 149 as COVID-19 (negative)
dialysis centers [Figure 1a]. An advisory was issued that all
COVID-19, positive or suspect, ESKD patients need to be
moved to these dedicated centers to continue their dialysis
care. This initiative was communicated via messaging
in the dedicated WhatsApp (WhatsApp Inc., Menlo
Park, California) Mumbai Nephrology Group to all 160
nephrologists and 174 dialysis centers, wherein the concept
was discussed and accepted by all members.
Establishment of a common portal: A coordination portal
called Covidialysis (https://covidialysis.in) was set up.
Later this portal was closed in Feb 2021, when it was
not required. The portal was designed as a progressive
web application accessible from a variety of operating
systems. A team of engineers from the Indian Institute
of Technology–Bombay (IITB) built, tested, improvised
the portal, and created a dashboard for real-time graph
generation from the data. A dashboard coordinator was
identied who had a comprehensive view of all enrolled
patients and available dialysis slots. His primary role
was to meet the demand for dialysis slots for COVID-19
(positive/suspect) patients in the minimum possible time, in
coordination with the persons in charge of the centers.
Foundation, 3Tata Centre for Technology and Design/Department of Industrial Engineering and Operations Research, Indian Institute of Technology,
Mumbai, Maharashtra, India, 4Division of Nephrology, PD Hinduja Hospital, 5Division of Nephrology, Dr. LH Hiranandani Hospital, 6Division of
Nephrology, BYL Nair Charitable Hospital, 7Division of Nephrology, King Edward Memorial Hospital, 8Division of Nephrology, Seven Hills Hospital,
9Division of Nephrology, Sir JJ Group of Hospitals, 10Division of Nephrology, Saifee Hospital, 11Division of Nephrology, Lokmanya Tilak Municipal
General Hospital, 12Division of Nephrology, Jupiter Hospital, 13Division of Transplantation, University of Pittsburgh Medical Center, USA, 14Division of
Nephrology, Ottawa Hospital, University of Ottawa, Canada, 15Municipal Corporation of Greater Mumbai, India
Address for correspondence:
Dr. Viswanath Billa,
Department of Nephrology, R. No. 6, 2nd Floor, New Wing, Bombay Hospital, Mumbai ‑ 400 020, Maharashtra, India.
E‑mail: billav@gmail.com
Figure 1: Distribution of hemodialysis facilities and COVID-19 patients
on MHD across the city of Mumbai. (a) Hemodialysis facilities were
strategically classied as COVID‑19 positive/suspect/negative by the
Municipal Corporation, to segregate and isolate COVID‑19‑infected
patients. (b) The density of infected patients as depicted by the heat map
mirrored the population density. (COVID‑19, Coronavirus disease 2019;
MHD, maintenance hemodialysis)
ab
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022 199
Registration and Communication: Each dialysis center
was registered on the portal using a Google Form
(Google Inc., Menlo Park, California), which included
details of its location, capacity, and dialysis shifts. The
designated person in charge of each center updated
the portal with the patient data on a Google Form
and could access it using a range of devices (laptops,
tablets, or smartphones). These persons in-charge were
responsible for transmitting information about new
COVID-19 (positive/suspect) cases to the dashboard
coordinator who guided the patient to a specied dialysis
slot in the city.
As the portal evolved, a data analytics interface was
incorporated. The results were visualized on a dashboard
built using Redash (Redash Ltd., Tel Aviv, Israel). All
tools that were used in putting together this platform were
FOSS (Free and Open-Source Software).
Patient management and transfer
There were no uniform COVID-19 testing policies in
dialysis centers in the city of Mumbai. Each center used
its own discretion to test patients, either as a screening tool
for all patients or testing only symptomatic ones. Once a
COVID-19 (positive/suspect) patient was identied, the
dashboard coordinator was notied, who promptly assigned
the patient to an appropriate COVID-19 facility. Each
patient was given the choice of COVID-positive facility
(public/private) to be transferred to. This eliminated conicts
pertaining to payments. To handle COVID-19 (suspect)
patients, the coordinator followed a similar procedure and
accommodated them within the suspect centers until the
test results became available, then they were triaged either
to a COVID-19 (positive) facility or back to their home
center based on the result. By capturing the PIN code of
each patient registered on the portal, every attempt was
made to accommodate these patients at the COVID-positive
facilities closest to their respective home PIN codes.
When there were bed availability issues, they were given
more distant options. The MCGM made arrangements
for dedicated COVID-positive vehicles to transport such
patients. There were also private paid services available for
the same. One of these available transportation options was
adopted.
Until July 2020, the RT-PCR (reverse transcription
polymerase chain reaction) test turnaround times (TAT) was
3 to 4 days. Later, as the TAT decreased to 24 hours, the
need for suspect facilities waned, and by August 2020, few
patients needed this service leading to decommissioning of
machines at these suspect centers.
Once patients became noninfective, they were
transferred back to their primary center. The duration
of stay at the designated COVID-19 facility changed
over time as the guidance changed from a test-based
isolation to a symptom- and duration-based framework.
Initially, every COVID-19 (positive) patient had to test
RT-PCR negative before being transferred out of the
COVID-19 (positive) facility.[5] However, in May 2020,
this guideline was modied, and any COVID-19 (positive)
patient who was asymptomatic and spent 14 days in the
COVID-19 (positive) facility could be transferred back
to their primary center without mandatory retesting. The
citywide population density of COVID-19 (positive)
patients on MHD is shown in Figure 1b. The schematic
in Figure 2a depicts the process of universal screening
of all patients at the dialysis centers, identication
of symptomatic patients, and transferring them into
COVID-19 (positive/suspect) facilities. Figure 2b depicts
the transfer process of COVID-19 (positive) patients
from the community dialysis centers into the designated
COVID-19 (positive) facilities assisted by the portal.
Data collection, analysis, and outcome
Data collection: All clinical data (age; gender;
comorbidities including hypertension, diabetes mellitus,
and ischemic heart disease; and duration on dialysis),
COVID-19 PCR status, testing dates, and hospitalization
details were recorded. In addition, transfer dates,
follow-up PCR test dates and transfers to primary dialysis
units, and death data were also recorded. The dashboard
captured data of the infected and suspect patients and
documented their mortality, recovery, and activity status
throughout the period of the pandemic. It also computed
the eciency of assigning COVID-19 (positive) patients
to suitable dialysis centers. This provided precise data of
case growth and projected resource needs. All collected
data were stored in a PostgreSQL database management
system on the Amazon Web Services (Amazon Inc.,
Seattle, Washington) cloud computing platform. The data
presented in this study include all COVID-19 (positive)
ESKD patients who were enrolled on the portal between
May 20, 2020, and December 31, 2020. Institutional
review board approval from IITB was taken to conduct
this study.
Analysis: All continuous variables were described as mean
with standard deviation, and categorical variables were
described as frequency and percentages. The mortality
rate was captured as a ratio of the number of deaths due
to COVID-19 to the total number of COVID-19 (positive)
cases. The analysis of outcomes between the survivors
and non-survivors of COVID-19 infection in the ESKD
population was done using the Fisher’s exact test.
Outcomes: The data from the portal described the
demographics of the aected population, mortality, risk
factors, transfer time to designated dialysis centers, and the
infection trend over time.
Oversight: The MCGM backed this eort. It sent a
mandate to all dialysis centers to ensure compliance with
full participation with this project.
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
200 Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022
Results
Study population
Of an estimated 10,000 ESKD patients on MHD in
the city of Mumbai, 1,418 (14%) patients developed
COVID-19 infection over the period of study.
COVID-19-infected patients originated from 106 of the
174 (61%) hemodialysis facilities across the city and
were transferred to 23 designated COVID-19 (positive)
centers. Figure 1a shows the distribution of hemodialysis
centers in the city. The heat map of the concentration of
COVID-19 (positive) cases across the city is shown in
Figure 1b. The origin of infected patients roughly mirrored
the population density across the city. There were 870
men (61%, mean age = 56 ± 15 years) and 548 women
(39%, mean age = 53 ± 13 years). Symptomatic patients
constituted 67% of all infected patients.
Incidence of COVID‑19 infection
The number of incident COVID-19 (positive) patients
peaked by late June and declined thereafter. There have
been minor spikes in the number of new cases during
certain periods, without a noticeable second wave as of
December 2020. The portal’s primary objective was to
allocate a COVID-19 (positive) hemodialysis slot to every
enrolled patient. This was met within 24 hours for 73%
patients, 48 hours for 97% patients, and 72 hours for all
patients. As shown in Figure 3, there was an initial surge of
COVID-19 (positive) cases in May, 2020. This was because
of the inclusion of not just the incident but also the prevalent
cases when the portal initially rolled out. Over time, there
was a general decline in the number of new cases.
COVID‑19 suspect cases
There were 156 patients who were COVID-19 (suspect)
over the period, of which 78 (50%) eventually tested
COVID-19 (positive).
Follow‑up COVID‑19 testing
During the study period, 47% of COVID-19 (positive)
patients underwent retesting by RT-PCR based on the
prevalent guidelines. In these patients, repeat COVID test
was negative after a median of 12 days (interquartile range
7–20 days).
Figure 2: COVID‑19 positive/suspect MHD patient handling and assignment to designated hemodialysis facilities. (a) Flow diagram – primary screening,
testing, enrollment, and transfer. (b) Schematic of portal‑directed assignment of patients to designated hemodialysis facilities. (COVID‑19, Coronavirus
disease 2019; MHD, maintenance hemodialysis; RT‑PCR, reverse transcription polymerase chain reaction)
b
a
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022 201
Outcomes
Outcomes over time in all patients are depicted in
Figures 4a and 4b. Of the 1,351 patients with known
outcomes, 370 died giving a mortality rate of 27% in
COVID-19 (positive) patients on MHD. This is against
a rate of 4% in the general population [Figure 4b].[2]
The mean age of patients who died was 60 ± 13 years
as compared with 52 ± 14 years in survivors. Time
to death was 7 days (interquartile range 2–15). There
was no statistical dierence in mortality between
the genders. Those patients who had one or more
comorbidities (hypertension, diabetes, or ischemic heart
disease) had a mortality of 51% as against 17% in those
without comorbidities. Mortality gures varied among
dierent COVID-19 (positive) health care facilities
ranging from 20% to 48%.
COVID‑19 infection among dialysis sta: The portal
also gathered information on COVID-19 infection
in hemodialysis personnel from 116/174 dialysis
centers (67%). COVID-19 infection occurred in
191 of 1,725 hemodialysis personnel (11%) from these
116 centers, with no deaths.
Thus, our prospective study showed a COVID-19
infection rate of 14% among a large cohort of chronic
MHD patients from multiple centers in a big metropolitan
city. The mortality rate in this group was 27%. The
IT platform and a collaborative approach between
nephrologists with oversight from the city Municipal
Corporation helped ensure the continuation of dialysis
care for these patients.
Discussion
Across the world, dashboards have taken a center stage
during the COVID-19 pandemic. The online interactive
dashboard from the Johns Hopkins University, Baltimore,
was the rst such publicly shared resource.[6] It has helped
researchers, public health authorities, and the public to
visualize and track reported cases of COVID-19 infections
and assisted with critical policy decision making as the
outbreak unfolded.[7-10]
We have previously reported a high incidence of infection
among ESKD patients on MHD in Mumbai.[1] In this study,
the crude incidence of COVID-19 is at least 14% with
possible ascertainment bias due to changing testing criteria
over time. The creation and deployment of the COVID-19
dashboard allowed the relatively seamless provision of
dialysis services across the public and private sector dialysis
facilities within the city, with 97% provision within 48 hours
and 100% within 72 hours for all COVID-19 suspect and
positive cases. This is in stark contrast to reports from
other places in the country where approximately 28%
patients missed one or more dialysis sessions, about
3% required emergency dialysis sessions, and about 4%
stopped reporting for dialysis.[11] The portal closely tracked
the outcomes of each of the 1,418 patients registered on it.
It ensured that each one received timely dialysis. None of
these patients, therefore, dropped out from dialysis owing
to this appropriate and timely intervention.
The portal concurrently compiled data of these patients
developing into a useful data resource for COVID-19
infection in hemodialysis patients in the city. In the
present study, 1,418 COVID-19 (positive) ESKD patients
in Mumbai constituted approximately 14% of all MHD
patients and 0.48% of the total number of infected cases
in the city as of December 31, 2020. The infection was
reported from 61% of all hemodialysis centers in the city.
Figure 3: Weekly enrollments of symptomatic/asymptomatic/suspect
patients onto the portal
Figure 4: Outcomes of COVID‑19 positive hemodialysis patients.
(a) Cumulative number of enrollments, recoveries, deaths, and active
patients over the study period. (b) Mortality rate due to COVID‑19 infection in
hemodialysis patients (blue curve) and in the general population (red curve)
during the study period. (COVID‑19, Coronavirus disease 2019)
a
b
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
202 Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022
The overall mortality of COVID-19 in this MHD setting
was 27%, in line with the reported literature.
The incidence of COVID-19 in published literature varies
from 2% (Wuhan) to 20% (London).[12,13] The cumulative
cases of COVID-19 in MHD patients in England ranged
from 0.9% to 33% in the individual region/centers, with
an overall incidence of 11%.[14] This variability could be
dependent on the community prevalence, testing policies
wherein all or only symptomatic patients were tested,
and other confounding factors. There were no uniform
COVID-19 testing policies in dialysis centers in the city
of Mumbai. Each center used its own discretion to test
patients, either as a screening tool for all patients or testing
only symptomatic ones. Of the patients registered on the
portal, 33% were asymptomatic. In the Brescia study, 19%
of COVID-19 (positive) patients were asymptomatic.[15]
This is in sharp contrast to a previous study from Mumbai
where all dialysis patients were tested and 74% of infected
patients were found to be asymptomatic.[1] It is yet unclear
whether the proportion of symptomatic and asymptomatic
patients is related to an impaired immune response due to
underlying CKD.[16]
The time to retest negative after enrollment was
16 ± 14 days (median 12 days). A previous study in
Mumbai that was done in the early epidemic period when
retesting was the rule, reported a 96% viral clearance rate
by Day 17.[1] Data from the United Kingdom reported that
on retesting in MHD patients after COVID-19 diagnosis,
only 59% tested negative by Day 15.[17] The available
data suggest that prolonged viral RNA (ribonucleic
acid) shedding after symptom resolution is not clearly
associated with prolonged infectiousness and may reect
replication-incompetent SARS-CoV-2.[18-20]
The mortality due to COVID-19 was 18% in the previous
study done in Mumbai and 16% in the Wuhan study.[1,21]
Several case series from Europe and the United States
with varying follow-up suggest a high mortality rate in
the dialysis population with rates ranging from 20% to
41%.[22-25] The mortality rate of 27% in MHD patients in
our study captures a longer duration of the pandemic and a
larger caseload than published data to date and is within the
range reported from the high-income countries mentioned
above.
The mortality rate was initially low when the portal was
deployed in late May 2020 (5%) possibly due to more
aggressive testing for the virus during this period with a
dilution of the numbers from milder and asymptomatic
cases that could lower the mortality rate.[26,27] This reached
a peak in July 2020 and then maintained a plateau
until December 2020, when the rate stood at 27%. This
stability of the number subsequently might also indicate
a degree of expertise in handling these patients as well as
standardization in testing protocols after July 2020.
It is now known that older age, cardiovascular disease,
diabetes, chronic respiratory disease, hypertension, and
cancer are associated with an increased risk of death in
COVID-19 infection.[28] Patients on MHD are at high risk
as they share similar comorbidities.[29] In our study, patients
who had at least one of three comorbidities (hypertension,
diabetes, or ischemic heart disease) had a mortality of 51%
as against 17% in those with none, reecting published
literature. The mortality in the top 10 hospitals that serviced
the maximum number of COVID-19 (positive) patients
ranged from 20% to 48%. This wide range in mortality
could be attributed to a referral bias, overburdening of
selective hospitals, and variation in treatment protocols.
Although 11% of the dialysis personnel contracted
COVID-19 infection, none of them died. The Wuhan
study had a lower rate of infection in hemodialysis
sta (3%).[30] This higher infection rate among sta in
our study is likely because it covered a longer duration of
the epidemic (7 months) compared with the Wuhan study
(2 weeks), as well as a higher community prevalence in
Mumbai compared with Wuhan. Younger age and lack of
comorbidities could potentially have contributed to the zero
mortality in dialysis caregivers.
This report has certain inherent limitations. Patients with
acute kidney injury due to COVID-19 were not included
in this study. This study was focused on ESKD patients
on MHD alone. We did not have the exact gure of the
number of patients undergoing MHD in the city. Also,
“Project Victory” was primarily aimed at ensuring the
allotment of dialysis slots to COVID-19 (positive) ESKD
patients; hence, the portal did not capture granular data
on hospitalization or intensive care admissions, ventilator
needs, or response to specic anti-COVID-19 therapies.
In conclusion, “Project Victory” is unique in being the
only such citywide, centralized, large, collective eort
utilizing a web-based portal to help COVID-19-infected
MHD patients secure a quick dialysis slot. It has the largest
number of reported cases of COVID-19 (positive) ESKD
patients from a single city. This project has helped health
care providers and administrators guide patients to access
chronic MHD services eciently. The overall incidence
of infection was 14% with a mortality of 27% among
COVID-19 positive cases. This mortality was due to the
complications arising out of COVID-19 infection and not
due to delayed or denied dialysis. With isolation, we may
have prevented the patient-to-patient and patient-to-sta
spread of the infection. The nephrology community and
the city administration embraced this multidimensional
initiative for a common cause, demonstrating the value of
collaborative health care management during a pandemic.
Acknowledgments
The authors would like to acknowledge the eorts of
the dialysis sta and health care workers in the city, the
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022 203
Municipal Corporation of Greater Mumbai, and the Indian
Institute of Technology, Bombay.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
References
1. Billa V, Kothari J, Bichu S, Kumar R, Usulumarty D, Tilve P,
et al. From infection to immunity: Impact of COVID-19 across
nine hemodialysis centers in Mumbai. Indian J Nephrol. in press.
2. Coronavirus Outbreak in India. Available from: www.
COVID19india.org.
3. “Mumbai”, Wikipedia. Available from: https://en.wikipedia.org/
wiki/Mumbai. [Last accessed on 2020 Nov 28].
4. Ramachandran R, Vivekanand J. Adding insult to injury: Kidney
replacement therapy during COVID-19 in India. Kidney Int
2020;98:238-9.
5. Centers for Disease Prevention and control. Discontinuation of
Transmission-Based Precautions and Disposition of Patients
with COVID-19 in Healthcare Settings (Interim Guidance).
Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/
disposition-hospitalized-patients.html.
6. Coronavirus Resource Center. John Hopkins University of
Medicine. Global map. Accessed from: https://coronavirus.jhu.
edu/map.html.
7. Dong E, Du H, Gardner L. An interactive web-based dashboard
to track COVID-19 in real time. Lancet Infect Dis 2020;20:533-4.
8. Grange ES, Neil EJ, Stoel M, Singh AP, Tseng E,
Resco-Summers K, et al. Responding to COVID-19: The UW
medicine information technology services experience. Appl Clin
Inform 2020;11:265-75.
9. Berry I, Soucy J, Tuite A, Fisman D. Open access epidemiologic
data and an interactive dashboard to monitor the COVID-19
outbreak in Canada. CMAJ 2020;192:E420.
10. Budd J, Miller BS, Manning EM, Lampos V, Zhuang M,
Edelstein M, et al. Digital technologies in the public-health
response to COVID-19. Nat Med 2020;26:1183-92.
11. Prasad N, Bhatt M, Agarwal SK, Kohli HS, Gopalakrishnan N,
Fernando E, et al. The adverse eect of COVID pandemic on the
care of patients with kidney diseases in India. Kidney Int Rep
2020;5:1545-50.
12. Xiong F, Tang H, Liu L, Tu C, Tian J, Lei C, et al. Clinical
characteristics of and medical interventions for COVID-19 in
hemodialysis patients in Wuhan, China. J Am Soc Nephrol
2020;31:1387-97.
13. Corbett RW, Blakey S, Nitsch D, Loucaidou M, McLean A,
Duncan N, et al. Epidemiology of COVID-19 in an urban
dialysis center. J Am Soc Nephrol 2020;31:1815-23.
14. The Renal Association. UKRR COVID-19 dataset. Available
from: https://renal.org/audit-research/data-permissions/data/
ukrr-covid-19-dataset.
15. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A,
et al. A report from the Brescia Renal COVID Task Force on the
clinical characteristics and short-term outcome of hemodialysis
patients with SARS-CoV-2 infection. Kidney Int 2020;98:20–6.
16. Ikizler TA. COVID-19 in dialysis patients: Adding a few more
pieces to the puzzle. Kidney Int 2020;98:17-9.
17. Dudreuilh C, Kumar N, Moxham V, Hemsley C, Goldenberg S,
Moutzouris DA. De-isolation of COVID-19-positive
hemodialysis patients in the outpatient setting: A single-center
experience. Kidney Int 2020;98:236-7.
18. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, et al. Viral
load dynamics and disease severity in patients infected with
SARS-CoV-2 in Zhejiang province, China, January-March 2020:
Retrospective cohort study. BMJ 2020;369:m1443.
19. Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S,
Müller MA, et al. Virological assessment of hospitalized patients
with COVID-2019. Nature 2020;581:465-9.
20. Chau NVV, Thanh Lam V, Thanh Dung N, Yen LM, Minh NNQ,
Hung LM, et al. The natural history and transmission potential
of asymptomatic SARS-CoV-2 infection. Clin Infect Dis
2020;71:2679–87.
21. Ma Y, Diao B, Lv X, Zhu J, Liang W, Liu L, et al. 2019 novel
coronavirus disease in hemodialysis (HD) patients: Report
from one HD center in Wuhan, China. medRxiv 2020. doi:
10.1101/2020.02.24.20027201.
22. Goicoechea M, Sánchez Cámara LA, Macías N,
Muñoz de Morales A, Rojas ÁG, Bascuñana A, et al. COVID-19:
Clinical course and outcomes of 36 hemodialysis patients in
Spain. Kidney Int 2020;98:27-34.
23. Sánchez-Alvarez E, Macía M, De Sequera Ortiz P. Management
of hemodialysis patients with suspected or conrmed
COVID-19 infection: Perspective from the Spanish nephrology.
Kidney360 2020;1:1254-8.
24. Jager KJ, Kramer A, Chesnaye NC, Couchoud C,
Sánchez-Álvarez JE, Garneata L, et al. Results from the
ERA-EDTA Registry indicate a high mortality due to COVID-19
in dialysis patients and kidney transplant recipients across
Europe. Kidney Int 2020;98:1540-8.
25. Valeri AM, Robbins-Juarez SY, Stevens JS, Ahn W, Rao MK,
Radhakrishnan J, et al. Presentation and outcomes of
patients with ESKD and COVID-19. J Am Soc Nephrol
2020;31:1409-15.
26. Abou Ghayda R, Lee KH, Han YJ, Ryu S, Hong SH, Yoon S,
et al. Estimation of global case fatality rate of coronavirus
disease 2019 (COVID-19) using meta-analyses: Comparison
between calendar date and days since the outbreak of the rst
conrmed case. Int J Infect Dis 2020;100:302-8.
27. Coronavirus Resource Center. John Hopkins University of
Medicine, 2020. Available from: http://coronavirus.jhu.edu/data/
mortality. [Last accessed on 2020 Nov 20].
28. Wu Z, McGoogan JM. Characteristics of and important lessons
from the Coronavirus Disease 2019 (COVID-19) outbreak
in China: Summary of a report of 72 314 cases from the
Chinese Center for Disease Control and Prevention. JAMA
2020;323:1239-42.
29. Kliger AS, Cozzolino M, Jha V, Harbert G, Ikizler TA. Managing
the COVID-19 pandemic: International comparisons in dialysis
patients. Kidney Int 2020;98:12-6.
30. Li J, Yang Y, Gong M, Shi J, Zhou X, Xing X, et al. Aggressive
quarantine measures reduce the high morbidity of COVID-19
in patients on maintenance hemodialysis and medical sta
of hemodialysis facilities in Wuhan, China. Kidney Dis
2020;6:271–83.
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
204 Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022
Appendix:
Other members of the Mumbai Nephrology
Group (Project Victory)
Shakir, Ahmad
Haridas, Ashwathy
Madan, Bahadur
Varun, Bansal
Vikas, Bharati
Amol, Bhawane
Harshal, Bhole
Nitin, Bhosale
Sandip, Bhurke
Pooja, Binani
Samuel, Chakola
Avinash, Chaudhari
Chandan, Chaudhari
Anup, Chaudhari
Hemant, Chaugule
Gaurav, Daga
Sudhiranjan, Dash
Keyur, Dave
Narendra, Dedhia
Paras, Dedhia
Jayesh D, Desai
Jayesh N, Desai
Rahul, Deshpande
Rushi, Deshpande
Martin, Desouza
Vaibhav, Dharap
Atit, Dharia
Haresh, Dodeja
Arun, Doshi
Rekha, Dubey
Bhupendra, Gandhi
Sohum, Gohil
Rajendra, Gunjotikar
Sachin, Gupta
Arun, Halankar
Atul, Ingale
Swapnil, Jadhav
Amit, Jain
Pankaj, Jawandhiya
Deepa, Jayaram
Makhija, Jhoomar
Vidya, Kadam
Shailesh, Kakde
Nikhil, Kedia
Vaibhav, Keskar
Jitendra, Khandge
Umesh, Khanna
Mustafa, Khokawala
Ashok, Kirpalani
Dilip, Kirpalani
Sachin, Kodgire
Amar, Kulkarni
Mihir, Kulkarni
Chaitanya, Kulkarni
Niranjan, Kulkarni
Arvind, Kunde
Siddharth, Lakhani
Amit, Langote
Dinesh, Mahajan
Jhoomar, Makhija
Raman, Malik
Hemant, Mehta
Mahendra, Merchant
Majid, Momin
Amit, Nagrik
Ravindra, Nikalji
Atim, Pajai
Aashay, Pandya
Harish, Pathak
Amjadkhan, Pathan
Ashwin, Patil
Rohan, Pradhan
Mahesh, Prasad
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
Billa, et al.: Mumbai’s dashboard approach for COVID‑19‑positive maintenance hemodialysis
Indian Journal of Nephrology | Volume 32 | Issue 3 | May-June 2022 205
Prashant, Rajput
Akash, Ranka
Alka, Rao
Ramesh, Rao
Ruchi, Samdhani
Salman, Sayyed
Neha, Shah
Sohil, Shah
Arun, Shah
Bharat, Shah
Hemal, Shah
Rechal, Shah
Hardik, Shah
Wasiyeeullah, Shaikh
Suyash, Sharma
Mukesh, Shete
Sharad, Sheth
Ashay, Shingare
Abhishek, Shrikhande
Anurag, Shukla
Akash, Singhada
Nitin, Sonawane
Lohitaksh, Suratkal
Rudramani, Swami
Shruti, Tapiawala
Aseem, Thamba
Parag, Tilve
Kirti, Upadhyay
Deepa, Usulumarthy
Bhavesh, Vora
Harshal, Vora
Sameer, Vyahalkar
Menal, Wali
Jyotsna, Zope
[Downloaded free from http://www.indianjnephrol.org on Wednesday, August 3, 2022, IP: 45.134.115.206]
