Nopsopon Tanawin, Kittrakulrat Jathurong, Takkavatakarn Kullaya, Eiamsitrakoon Thanee, Kanjanabuch Talerngsak, Pongpirul Krit
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
PLoS Negl Trop Dis. 2021 Jun 15;15(6):e0009156. doi: 10.1371/journal.pntd.0009156. eCollection 2021 Jun.
The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT.
METHODOLOGY/PRINCIPAL FINDINGS: We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25-5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09-22.32) which was higher than the global average at 4.98%.
This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的新型冠状病毒（COVID-19）在患有不同基础慢性病的患者中呈现出不同的患病率和病死率（CFR）。接受肾脏替代治疗（RRT）的终末期肾病（ESRD）患者可能由于尿毒症导致免疫功能降低以及SARS-CoV-2对肾脏的嗜性而具有较高的患病率和病死率，但缺乏对接受各种RRT的ESRD患者中SARS-CoV-2感染及死亡率的系统研究。
方法/主要发现：我们检索了五个电子数据库，并进行了一项系统评价和荟萃分析，直至2020年6月30日，以评估接受RRT的ESRD患者中COVID-19感染的患病率和病死率（CFR）。2020年6月30日从国际数据库检索全球COVID-19数据，以估计一般人群的患病率和CFR作为参考点。在3272项潜在研究中，34项为符合条件的研究，包括来自世界卫生组织四个区域12个国家的21873例接受RRT的ESRD患者中的1944例COVID-19确诊病例。接受RRT的ESRD患者的总体合并患病率为3.10%[95%置信区间（CI）1.25 - 5.72]，高于全球平均患病率0.14%。接受RRT的ESRD患者中COVID-19的总体估计病死率为18.06%（95%CI 14.09 - 22.32），高于全球平均水平4.98%。
这项荟萃分析表明，接受RRT的ESRD患者中COVID-19患病率和病死率较高。接受RRT的ESRD患者应有其特定的COVID-19预防和治疗方案，以减少额外的病例和死亡。
