新冠后状况给晚期慢性肾病患者带来重大负担：一项巢式病例对照研究。

Post COVID-19 condition imposes significant burden in patients with advanced chronic kidney disease: A nested case-control study.

作者信息

Bouwmans Pim, Malahe S Reshwan K, Messchendorp A Lianne, Vart Priya, Imhof Céline, Sanders Jan-Stephan F, Gansevoort Ron T, de Vries Aiko P J, Abrahams Alferso C, Bemelman Frederike J, Vervoort Johanna P M, Hilbrands Luuk B, Ten Dam Marc A G J, van den Dorpel René M A, Rispens Theo, Steenhuis Maurice, Reinders Marlies E J, Hemmelder Marc H

机构信息

Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands.

Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Int J Infect Dis. 2024 May;142:106990. doi: 10.1016/j.ijid.2024.106990. Epub 2024 Feb 28.

DOI:10.1016/j.ijid.2024.106990

PMID:38428480

Abstract

BACKGROUND

The burden of post COVID-19 condition (PCC) is not well studied in patients with advanced kidney disease.

METHODS

A large prospective cohort of SARS-CoV-2 vaccinated patients with chronic kidney disease stages G4-G5 (CKD G4/5), on dialysis, and kidney transplant recipients (KTR) were included. Antibody levels were determined after vaccination. Presence of long-lasting symptoms was assessed in patients with and without prior COVID-19 and compared using logistic regression. In patients with prior COVID-19, PCC was defined according to the WHO definition.

RESULTS

Two hundred sixteen CKD G4/5 patients, 375 dialysis patients, and 2005 KTR were included. Long-lasting symptoms were reported in 204/853 (24%) patients with prior COVID-19 and in 297/1743 (17%) patients without prior COVID-19 (aOR: 1.45 (1.17-1.78)], P < 0.001). PCC was prevalent in 29% of CKD G4/5 patients, 21% of dialysis patients, and 24% of KTR. In addition, 69% of patients with PCC reported (very) high symptom burden. Odds of PCC was lower per 10-fold increase in antibody level after vaccination (aOR 0.82 [0.70-0.96], P = 0.01) and higher in case of COVID-19 related hospital admission (aOR 4.64 [2.61-8.25], P = 0.003).

CONCLUSIONS

CKD G4/5 patients, dialysis patients, and KTR are at risk for PCC with high symptom burden after SARS-CoV-2 vaccination, especially if antibody levels are low and in case of hospitalization due to COVID-19.

摘要

背景

新型冠状病毒肺炎后状况（PCC）在晚期肾病患者中的负担尚未得到充分研究。

方法

纳入了一个大型前瞻性队列，其中包括接种了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗的慢性肾脏病G4-G5期（CKD G4/5）患者、透析患者和肾移植受者（KTR）。接种疫苗后测定抗体水平。评估有无新型冠状病毒肺炎病史患者的长期症状，并采用逻辑回归进行比较。在有新型冠状病毒肺炎病史的患者中，PCC根据世界卫生组织的定义确定。

结果

纳入了216例CKD G4/5患者、375例透析患者和2005例KTR。有新型冠状病毒肺炎病史的204/853例（24%）患者和无新型冠状病毒肺炎病史的297/1743例（17%）患者报告有长期症状（调整后比值比：1.45[1.17-1.78]，P<0.001）。PCC在29%的CKD G4/5患者、21%的透析患者和24%的KTR中普遍存在。此外，69%的PCC患者报告（非常）高症状负担。接种疫苗后抗体水平每增加10倍，PCC的几率降低（调整后比值比0.82[0.70-0.96]，P=0.01），而与新型冠状病毒肺炎相关的住院患者中PCC的几率更高（调整后比值比4.64[2.61-8.25]，P=0.003）。