Albert Einstein College of Medicine, Bronx, New York.
Division of Nephrology, Montefiore Medical Center, Bronx, New York.
Kidney360. 2020 Jun 18;1(8):755-762. doi: 10.34067/KID.0003672020. eCollection 2020 Aug 27.
Patients with ESKD who are on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population are limited. The aim of our study is to describe the clinical characteristics and short-term outcomes in patients on chronic hemodialysis who require hospitalization for COVID-19.
We performed a retrospective study of 114 patients on chronic hemodialysis who were hospitalized with COVID-19 at two major hospitals in the Bronx from March 9 to April 8, 2020 during the surge of SARS-CoV-2 infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short-term outcomes were reported.
Median age was 64.5 years, 61% were men, and 89% were black or Hispanic. A total of 102 (90%) patients had hypertension, 76 (67%) had diabetes mellitus, 63 (55%) had cardiovascular disease, and 30% were nursing-home residents. Intensive care unit (ICU) admission was required in 13% of patients, and 17% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 87% of those requiring ICU, and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein, and lymphocyte percentage were associated with in-hospital death.
Short-term mortality in patients on chronic hemodialysis who were hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in patients with ESKD who are hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in patients with ESKD who were hospitalized with COVID-19.
患有终末期肾病（ESKD）并接受慢性血液透析的患者合并症负担较重，在因 COVID-19 住院时发生不良结局的风险可能增加。然而，针对这一特殊患者群体的数据有限。本研究旨在描述因 COVID-19 住院的慢性血液透析患者的临床特征和短期结局。
我们对 2020 年 3 月 9 日至 4 月 8 日期间，在纽约市 SARS-CoV-2 感染激增期间，两家位于布朗克斯区的主要医院因 COVID-19 住院的 114 名慢性血液透析患者进行了回顾性研究。通过 2020 年 4 月 22 日对患者进行随访。比较了存活患者和住院期间死亡患者的临床特征和实验室数据；报告了短期结局。
中位年龄为 64.5 岁，61%为男性，89%为黑人和/或西班牙裔。102 名（90%）患者患有高血压，76 名（67%）患有糖尿病，63 名（55%）患有心血管疾病，30%为疗养院居民。13%的患者需要入住重症监护病房（ICU），17%的患者需要机械通气。该队列中有 28%的患者发生院内死亡，87%的 ICU 患者，近 100%的机械通气患者。观察到大量院内心脏骤停。入院时的降钙素原、铁蛋白、乳酸脱氢酶、C 反应蛋白和淋巴细胞百分比与院内死亡相关。
因 COVID-19 住院的慢性血液透析患者的短期死亡率较高。需要 ICU 和机械通气的患者结局较差，这突出表明对于因严重 COVID-19 住院的终末期肾病患者，应进行临终讨论，并且在 COVID-19 环境中需要提高对急性心脏事件的认识。入院时炎症标志物升高与因 COVID-19 住院的终末期肾病患者的院内死亡相关。
