Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
The Columbia University Renal Epidemiology Group, New York, New York.
J Am Soc Nephrol. 2020 Jul;31(7):1409-1415. doi: 10.1681/ASN.2020040470. Epub 2020 May 28.
The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.
Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×10/l), as was C-reactive protein (163 versus 80 mg/L).
The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.
接受透析的终末期肾病 (ESKD) 患者免疫抑制相对较强，合并症高发，这令人担忧他们可能有发生严重 2019 冠状病毒病 (COVID-19) 的风险增加，但此类患者 COVID-19 的结局尚不清楚。
为了研究透析 ESKD 患者 COVID-19 的表现和结局，我们回顾性收集了 59 例因 COVID-19 住院的透析患者的临床数据。我们使用 Wilcoxon 秩和检验和 Fischer 确切检验比较了死亡患者与存活患者。
59 例患者中有 2 例正在接受腹膜透析，57 例正在接受血液透析。中位年龄为 63 岁，高血压（98%）和糖尿病（69%）高发。死亡患者显著比存活患者年龄大（中位年龄，75 岁比 62 岁），Charlson 合并症指数中位值更高（8 分比 7 分）。最常见的首发症状为发热（49%）和咳嗽（39%）；初始影像学最常显示多灶性或双侧混浊（59%）。随访结束时，18 例患者（31%）在住院后中位 6 天死亡，包括需要机械通气的患者中的 75%。死亡患者中有 11 例有反对插管的预先指示。其余 41 例患者（69%）在中位住院 8 天后出院。与存活患者相比，死亡患者的初始白细胞计数（7.5×10^9/L 比 5.7×10^9/L）和 C 反应蛋白（163 mg/L 比 80 mg/L）明显更高。
透析 ESKD 患者 COVID-19 死亡率高，这强调需要采取适当的感染控制措施，以防止该脆弱人群 COVID-19 传播。
