Chen Chun-Yu, Shao Shih-Chieh, Chen Yih-Ting, Hsu Cheng-Kai, Hsu Heng-Jung, Lee Chin-Chan, Sun Chiao-Yin, Chen Yung-Chan, Hung Ming-Jui, Wu I-Wen
Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Healthcare (Basel). 2021 Jan 5;9(1):47. doi: 10.3390/healthcare9010047.
Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September 2020. Two independent researchers extracted data and study-level risk of bias across studies. We conducted meta-analysis of proportions for incidence and mortality rate. Study heterogeneity and publication bias were assessed. A total of 29 articles with 3261 confirmed COVID-19 cases from a pool of 396,062 HD patients were identified. Incidence of COVID-19 in these HD patients was 7.7% (95% CI: 5.0-10.9%; study heterogeneity: I2 = 99.7%, < 0.001; risk of publication bias, Egger's test, < 0.001). Overall mortality rate was 22.4% (95% CI: 17.9-27.1%; study heterogeneity: I2 = 87.1%, < 0.001; risk of publication bias, Egger's test: = 0.197) in HD patients with COVID-19. Reported estimates were higher in non-Asian than Asian countries. Quality of study may affect the reported incidence but not the mortality among studies. Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection. International collaboration and standardized reporting of epidemiological data should be needed for further studies.
血液透析（HD）患者极易感染新型冠状病毒肺炎（COVID-19）。然而，目前关于HD患者感染COVID-19的现有证据的综合评估仍不完整。我们系统检索了PUBMED和EMBASE，以查找截至2020年9月发表的关于HD患者感染COVID-19的发病率或死亡率的文章。两名独立研究人员提取了数据和各研究的研究水平偏倚风险。我们对发病率和死亡率进行了比例的荟萃分析。评估了研究异质性和发表偏倚。共识别出29篇文章，涉及来自396,062名HD患者中的3261例确诊COVID-19病例。这些HD患者中COVID-19的发病率为7.7%（95%置信区间：5.0-10.9%；研究异质性：I2 = 99.7%，P < 0.001；发表偏倚风险，Egger检验，P < 0.001）。COVID-19 HD患者的总体死亡率为22.4%（95%置信区间：17.9-27.1%；研究异质性：I2 = 87.1%，P < 0.001；发表偏倚风险，Egger检验：P = 0.197）。非亚洲国家报告的估计值高于亚洲国家。研究质量可能会影响报告的发病率，但不会影响研究中的死亡率。HD患者中COVID-19感染的发病率和死亡率均较高。现有数据可能低估了实际感染率。进一步的研究需要国际合作和标准化的流行病学数据报告。
