Toda Masataro, Yoshifuji Ayumi, Fujii Kentaro, Komatsu Motoaki, Kato Ai, Tamura Ikue, Sugi Wataru, Ryuzaki Munekazu
Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073 Japan.
Ren Replace Ther. 2022;8(1):22. doi: 10.1186/s41100-022-00408-5. Epub 2022 May 20.
We experienced that some hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) exacerbated hypoxemia during HD. Though HD-induced hypoxemia has been reported, there have been no reports of HD-induced hypoxemia in patients with COVID-19 and its effect on prognosis of COVID-19.
Eleven HD patients admitted with COVID-19 from August 2020 to April 2021 were classified into the patients whose oxygen demand increased by more than 3 L/min with mask during HD (worsened group, = 5) and others (not-worsened group, = 6). The background, laboratory findings, severity of COVID-19 and prognosis were compared between the two groups. In addition, blood gases were measured before and after dialysis among HD patients admitted with COVID-19 on April 2021 ( = 3).
There were no significant differences in backgrounds, except for a higher proportion of diabetes mellitus in worsened group ( = 0.04). Although laboratory findings were not significantly different on admission day, albumin and LDH levels 7 days after admission were significantly lower and higher in worsened group, respectively ( = 0.03 and < 0.01). The severity of COVID-19 and survival rate were significantly worse in worsened group ( = 0.01 and 0.03). The alveolar-arterial oxygen pressure difference (Aa-DO) opened during HD in a patient with HD-induced hypoxemia, but did not open in patients without HD-induced hypoxemia.
There is a close relationship among HD-induced hypoxemia and poor prognosis of COVID-19. The HD-induced hypoxemia of patients with COVID-19 may be caused by ventilation/perfusion mismatching.
The online version contains supplementary material available at 10.1186/s41100-022-00408-5.
我们发现一些2019冠状病毒病（COVID-19）血液透析（HD）患者在血液透析期间低氧血症加重。虽然已有血液透析引起低氧血症的报道，但尚无关于COVID-19患者血液透析引起低氧血症及其对COVID-19预后影响的报道。
将2020年8月至2021年4月收治的11例COVID-19血液透析患者分为血液透析期间面罩吸氧需求增加超过3L/min的患者（病情恶化组，n = 5）和其他患者（病情未恶化组，n = 6）。比较两组患者的背景、实验室检查结果、COVID-19严重程度及预后。此外，对2021年4月收治的COVID-19血液透析患者（n = 3）透析前后的血气进行了检测。
除病情恶化组糖尿病比例较高外（P = 0.04），两组患者背景无显著差异。虽然入院当天实验室检查结果无显著差异，但病情恶化组入院7天后白蛋白水平显著降低，乳酸脱氢酶水平显著升高（P = 0.03和P<0.01）。病情恶化组COVID-19严重程度和生存率显著更差（P = 0.01和P = 0.03）。1例血液透析引起低氧血症的患者在血液透析期间肺泡-动脉血氧分压差（Aa-DO）增大，而未发生血液透析引起低氧血症的患者未增大。
血液透析引起的低氧血症与COVID-19预后不良密切相关。COVID-19患者血液透析引起的低氧血症可能是由通气/血流不匹配所致。
在线版本包含可在doi:10.1186/s41100-022-00408-5获取的补充材料。
