Lamech Tanuj Moses, Nithya Govindasamy, Aiswarya Dhanapalan, Gopalakrishnan Natarajan, Vathsalyan Paulpandian, Sajmi Shaji, Goutham Kamalakannan, Krishna Ravindran, Dineshkumar Thanikachalam, Sakthirajan Ramanathan, Dhanapriya Jeyachandran, Padmaraj Rajendran
Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2022 Jan-Feb;32(1):16-21. doi: 10.4103/ijn.IJN_511_20. Epub 2021 Dec 30.
Several months into the coronavirus disease 2019 (COVID-19) pandemic, there remains a paucity of data on the behavior of the disease in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD). Here, we describe the clinical presentations, biochemical profile, and outcomes of 183 such patients from a large tertiary-care center in South India.
This prospective, observational study, included all patients with COVID-19 and ESKD who received at least one session of hemodialysis at our center, from the start of the outbreak to July 9, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed.
A total of 183 patients were included in the analysis. Patients who had symptoms at presentation accounted for 49.18% of the cohort, with the most common symptoms being fever (87.1%), cough (67.7%), and breathlessness (63.4%). Factors independently associated with mortality on univariate analysis included age ≥60 years, having symptoms at presentation, neutrophil-lymphocyte ratio >6, C-reactive protein >20 mg/L, serum lactate dehydrogenase >250 IU/L, CT (computed tomography) Grades 3 and 4, and the need for respiratory support. However, on multivariate logistic regression analysis, the only factor that retained significance was an age >60 years.
This analysis confirms the previous reports of higher COVID-19-related mortality in the dialysis population and identifies older age, higher inflammatory markers, and greater degrees of radiological lung involvement to correlate with increased mortality.
在2019冠状病毒病（COVID-19）大流行数月后，关于维持性血液透析（MHD）的终末期肾病（ESKD）患者的疾病行为的数据仍然很少。在此，我们描述了来自印度南部一家大型三级医疗中心的183例此类患者的临床表现、生化特征和预后。
这项前瞻性观察性研究纳入了自疫情开始至2020年7月9日在我们中心接受至少一次血液透析的所有COVID-19和ESKD患者。分析了就诊时的临床特征、实验室和放射学数据以及预后。
共有183例患者纳入分析。就诊时有症状的患者占队列的49.18%，最常见的症状是发热（87.1%）、咳嗽（67.7%）和呼吸困难（63.4%）。单因素分析中与死亡率独立相关的因素包括年龄≥60岁、就诊时有症状、中性粒细胞与淋巴细胞比值>6、C反应蛋白>20 mg/L、血清乳酸脱氢酶>250 IU/L、CT（计算机断层扫描）3级和4级以及需要呼吸支持。然而，多因素逻辑回归分析显示，唯一保持显著意义的因素是年龄>60岁。
该分析证实了先前关于透析人群中COVID-19相关死亡率较高的报道，并确定年龄较大、炎症标志物水平较高以及肺部放射学累及程度较大与死亡率增加相关。
