Fontana Francesco, Giaroni Francesco, Frisina Monica, Alfano Gaetano, Mori Giacomo, Lucchi Leonardo, Magistroni Riccardo, Cappelli Gianni
Struttura Complessa di Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Surgical Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Clin Kidney J. 2020 Jun 22;13(3):334-339. doi: 10.1093/ckj/sfaa084. eCollection 2020 Jun.
Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units.
We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2.
We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5-14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25-23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75-9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients).
We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.
透析患者被认为是感染新型冠状病毒肺炎（COVID-19）的高危人群，且感染容易在透析单元传播。
我们开展了一项单中心观察性队列研究，以描述感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的透析患者的临床特征、治疗方法及预后。我们对出现症状或与确诊病例有接触的患者进行检测。共纳入15例SARS-CoV-2检测呈阳性的患者。
我们对306例透析患者中的37例进行了检测。感染SARS-CoV-2的患者年龄较大（平均年龄75.96±11.09岁），且均患有合并症。就诊时，大多数患者胸部X线显示间质浸润，四分之三的患者白细胞减少，且无一例出现呼吸功能不全。在随访期间，血清C反应蛋白和白细胞介素-6升高。80%的患者接受了吸氧治疗；无人接受无创通气，1例进行了气管插管。大多数患者（80%）接受了口服羟氯喹治疗，中位时间为6.5天[四分位间距（IQR）5 - 14.5]，40%的患者接受了阿奇霉素治疗；2例患者接受了短疗程抗病毒药物治疗，1例患者接受了单剂量托珠单抗治疗。仅2例患者无需住院治疗。9例幸存者中，8例在诊断后中位19天（IQR 9.25 - 23）时SARS-CoV-2检测仍呈阳性。6例患者死亡（病死率40%），诊断后中位5.5天（IQR 1.75 - 9.75）。报告的主要死亡原因是与COVID-19相关的呼吸衰竭（5例患者）。
我们报告了透析患者感染SARS-CoV-2的单中心经验。该疾病显示出高病死率，且大多数患者需要住院治疗。幸存者病毒清除时间延长。
