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床边短期肾脏替代治疗为公共卫生危机期间维持性血液透析患者治疗非危重型 2019 冠状病毒病提供了一种可能的选择。

Bed-sided short-duration renal replacement therapy provide a possible option to treat non-critical coronavirus disease 2019 in maintenance hemodialysis patients in public health crisis.

机构信息

Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China.

The Second Affiliated College of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.

出版信息

Ther Apher Dial. 2021 Feb;25(1):55-65. doi: 10.1111/1744-9987.13590. Epub 2020 Oct 26.

Abstract

HD care may experience great stress with the coronavirus disease 2019 (COVID-19) pandemic. A modified HD modality named bed-sided short-duration renal replacement therapy (BSRRT) was used in noncritical maintenance HD (MHD) patients diagnosed with COVID-19 in Wuhan due to extreme situation. To determine the safety and efficacy as a substitution for intermittent HD (IHD), we conducted this study. We used the data of 88 noncritical COVID-19 MHD patients collected from 65 medical units at the hospitals in Wuhan, China, from January 1 to March 10, 2020. t-test, Wilcoxon rank sum test, and Fisher exact probability method were used to compare the baseline characteristics, treatment, and death. Log-rank test and Cox regression multivariate analysis was used to compare the survival of noncritical patients who were transferred to BSRRT modality versus those who were continued on the IHD. Univariate analysis showed the level of reported fatigue symptom at present, bilateral lung computed tomography infiltration and steroid treatment differed between the two groups. The outcome of death of the two groups did not show significant differences in univariate analysis (P = .0563). Multivariate Cox regression analysis dialysis showed modality of treatment after COVID-19 diagnosis was not a significant predictor of death (P = .1000). These data suggest that for noncritical COVID-19 MHD patients, the transfer from IHD to BSRRT does not have significant difference in the risk of death compared with IHD group. This finding suggests this modified modality could be an option for the substitution for IHD during the COVID-19 pandemic period.

摘要

HD 医护人员可能会因 2019 年冠状病毒病(COVID-19)大流行而面临巨大压力。在武汉,由于极端情况,为确诊 COVID-19 的非重症维持性血液透析(MHD)患者采用了一种改良的血液透析模式,即床边短时程肾脏替代治疗(BSRRT)。为了确定其作为间歇性血液透析(IHD)替代疗法的安全性和有效性,我们进行了这项研究。我们使用了 2020 年 1 月 1 日至 3 月 10 日期间从中国武汉的 65 个医疗单位收集的 88 名非重症 COVID-19 MHD 患者的数据。采用 t 检验、Wilcoxon 秩和检验和 Fisher 确切概率法比较两组患者的基线特征、治疗和死亡情况。Log-rank 检验和 Cox 回归多因素分析用于比较转用 BSRRT 模式和继续 IHD 治疗的非重症患者的生存情况。单因素分析显示,两组患者目前报告的疲劳症状水平、双肺计算机断层扫描浸润和激素治疗存在差异。两组患者的死亡结局在单因素分析中差异无统计学意义(P=0.0563)。多因素 Cox 回归分析显示,COVID-19 诊断后治疗方式不是死亡的显著预测因素(P=0.1000)。这些数据表明,对于非重症 COVID-19 MHD 患者,与 IHD 组相比,从 IHD 转用 BSRRT 并不会增加死亡风险。这一发现表明,在 COVID-19 大流行期间,这种改良模式可能是 IHD 的替代选择。

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本文引用的文献

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Mitigating Risk of COVID-19 in Dialysis Facilities.降低透析机构中新冠病毒病的风险
Clin J Am Soc Nephrol. 2020 May 7;15(5):707-709. doi: 10.2215/CJN.03340320. Epub 2020 Mar 20.

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