Atris Ahmed, Al Salmi Issa, Hannawi Suad
Department of Renal Medicine, Royal Hospital, Muscat, Oman.
Internal Medicine, Oman Medical Specialty Board, Muscat, Oman.
Oman Med J. 2021 Sep 30;36(5):e312. doi: 10.5001/omj.2022.38. eCollection 2021 Sep.
Hemodialysis is a medical procedure to correct electrolyte imbalance and remove fluids and waste products from the blood of patients with end-stage renal disease. Dialysis patients are immunosuppressed and hence at risk of complications of coronavirus infection. In addition, dialysis for most patients is performed in-center, with therapy offered three times per week for 3.5 hours per session in sites highly exposed to virus contamination. A weak immune system and low cytokine storm explain why COVID-19 may be less severe in dialysis patients as death due to COVID-19 or effects on comorbidities in COVID-19 patients is due to overresponse against the virus by the immune system and cytokine storm. However, during the frequent trips between the dialysis center and home, the risk of coronavirus infection could be high. Moreover, hemodialysis patients constitute a distinct and high-risk group that is often associated with low immunity, decline or loss of the ability to work, substantial economic burden, the inability to fulfill family responsibilities and participate in an active social life, and suffer from various complications such as muscle weakness, pruritus, fatigue, diabetes, hypertension, and restless legs. These factors are associated with lower quality of life and poor clinical outcomes, leading to a higher risk of psychological problems than in the general population. We report a rare case of new-onset psychosis (mostly delirium) following COVID-19 infection in a middle-aged hemodialysis patient with rapid recovery.
血液透析是一种医疗程序，用于纠正电解质失衡，并从终末期肾病患者的血液中清除液体和废物。透析患者免疫功能低下，因此有感染冠状病毒并发症的风险。此外，大多数患者在中心进行透析，每周进行三次治疗，每次治疗3.5小时，而这些场所极易受到病毒污染。免疫系统薄弱和细胞因子风暴较弱可以解释为什么COVID-19在透析患者中可能症状较轻，因为COVID-19导致的死亡或对COVID-19患者合并症的影响是由于免疫系统对病毒的过度反应和细胞因子风暴。然而，在透析中心和家之间频繁往返期间，感染冠状病毒的风险可能很高。此外，血液透析患者构成了一个独特的高危群体，他们往往免疫力低下、工作能力下降或丧失、经济负担沉重、无法履行家庭责任和参与积极的社会生活，并患有各种并发症，如肌肉无力、瘙痒、疲劳、糖尿病、高血压和不安腿综合征。这些因素与生活质量较低和临床结果较差相关，导致心理问题的风险高于普通人群。我们报告了一例罕见的病例，一名中年血液透析患者在感染COVID-19后出现新发精神病（主要是谵妄），但恢复迅速。
