"Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.
Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Ren Fail. 2021 Dec;43(1):49-57. doi: 10.1080/0886022X.2020.1853571.
There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries.
In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR.
The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir-ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality.
In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.
关于 COVID-19 维持性血液透析患者的临床特征、治疗和转归，信息有限。此外，由于各国疫情的范围和严重程度不同，也可以想象存在地区差异。
在这项回顾性、观察性、单中心研究中，我们分析了 2020 年 3 月 24 日至 5 月 22 日期间因 COVID-19 住院的 37 名维持性血液透析患者（中位年龄 64 岁，51%为男性）的临床过程和结局，这些患者的确诊均通过实时 PCR 检测。
入院时最常见的症状是疲劳（51%）、发热（43%）、呼吸困难（38%）和咳嗽（35%）。59%为轻症/中度患者，41%为重症/危重症患者。重症/危重症组患者的动脉粥样硬化负担明显更高，因为糖尿病肾病和血管性肾病是最常见的原发性肾脏疾病，其中 80%患有冠心病。此外，该组的 Charlson 合并症评分也更高。入院时的胸部 X 线检查，46%有磨玻璃样异常。总体而言，60%的患者接受羟氯喹治疗，22%接受洛匹那韦/利托那韦治疗，11%接受托珠单抗治疗，24%接受全身糖皮质激素治疗，54%接受预防性抗凝治疗。7 名（19%）患者在住院期间死亡，30 名患者出院。死亡的主要原因是心血管疾病（5 例）和呼吸窘迫综合征（2 例）。在 Cox 回归分析中，入院时较低的氧饱和度、贫血和低白蛋白血症与死亡率增加相关。
总之，我们观察到 COVID-19 住院维持性血液透析患者的死亡率较高。入院时贫血、低血清白蛋白和低基础氧饱和度是预后不良的相关因素。
