Division of Nephrology, Dialysis and Hypertension, AZ Nikolaas Hospital, Sint-Niklaas, Belgium.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
J Am Soc Nephrol. 2021 Feb;32(2):385-396. doi: 10.1681/ASN.2020060875. Epub 2020 Nov 5.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial.
To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19).
At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection.
Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染对体弱、老年患者和患有多种慢性合并症的患者影响不成比例。接受肾脏替代治疗（RRT）的患者是否因特定暴露和复杂的免疫失调而面临额外风险仍存在争议。
为了描述 SARS-CoV-2 感染的发生率、特征和结局，我们于 2020 年 3 月 2 日至 5 月 25 日，在比利时佛兰德斯地区进行了一项前瞻性、多中心、全地区注册研究，比较了接受 RRT 的成年患者与普通人群。该研究包括了比利时佛兰德斯地区所有接受 RRT 的患者，该国受到了 2019 年冠状病毒病（COVID-19）的严重影响。
在疫情高峰期，接受血液透析的 4297 例患者中 SARS-CoV-2 感染的粗发病率和年龄标准化累积发病率分别为 5.3%和 2.5%，接受肾移植的 3293 例患者分别为 1.4%和 1.6%（相比之下，普通人群中为 0.6%）。接受血液透析的患者中，粗发病率和年龄标准化累积死亡率分别为 29.6%和 19.9%，接受肾移植的患者分别为 14.0%和 23.0%（相比之下，普通人群中为 15.3%）。与 2015-2019 年同期的平均死亡率相比，我们发现血液透析患者的死亡率并没有增加，因为 COVID-19 死亡率被未感染患者的预期死亡率降低所平衡。只有 0.18%的肾移植患者死于 SARS-CoV-2 感染。
接受 RRT 的患者因 SARS-CoV-2 感染而导致的死亡率很高。然而，在佛兰德斯，该流行病对 RRT 人群的整体影响仍然非常有限。超额死亡率的计算和年龄标准化提供了一个更可靠的 COVID-19 对接受 RRT 的患者死亡率负担的图景。
