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
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.
Int J Infect Dis. 2024 May;142:106990. doi: 10.1016/j.ijid.2024.106990. Epub 2024 Feb 28.
The burden of post COVID-19 condition (PCC) is not well studied in patients with advanced kidney disease.
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.
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).
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.
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。
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。
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）。
CKD G4/5患者、透析患者和KTR在接种SARS-CoV-2疫苗后有发生PCC且症状负担高的风险，尤其是抗体水平低以及因新型冠状病毒肺炎住院的患者。
