Delfino-Pereira Polianna, Ventura Vanessa das Graças José, Pires Magda Carvalho, Ponce Daniela, do Carmo Gabriel Assis Lopes, do Carmo Lilian Pires de Freitas, de Paiva Bruno Barbosa Miranda, Schwarzbold Alexandre Vargas, Gomes Angélica Gomides Dos Reis, de Castro Bruno Mateus, Polanczyk Carísi Anne, Cimini Christiane Corrêa Rodrigues, de Lima Daniela Antunes, de Sousa Fabiano Carvalho, Bartolazzi Frederico, Vietta Giovanna Grunewald, Vianna Heloisa Reniers, Chatkin José Miguel, Ruschel Karen Brasil, Kopittke Luciane, de Castro Luís César, Carneiro Marcelo, Dos Reis Priscilla Pereira, Marcolino Milena Soriano
Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Institute for Health Technology Assessment (IATS), Porto Alegre, Brazil.
Front Med (Lausanne). 2024 Apr 15;11:1350657. doi: 10.3389/fmed.2024.1350657. eCollection 2024.
Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% . 8.8%, < 0.001), septic shock (24.1% . 12.0%, = 0.002), and mortality (32.5% . 23.3%, = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.
慢性肾脏病（CKD）患者，尤其是那些接受透析治疗或已接受肾移植（KT）的患者，被认为更容易感染重症新型冠状病毒肺炎（COVID-19）。这种易感性归因于高龄、更高的合并症发生率以及慢性免疫抑制状态，这些因素可能会加剧他们发生严重后果的易感性。因此，我们的研究旨在通过倾向评分匹配队列研究，比较肾移植患者、慢性透析患者和非CKD患者中COVID-19的临床特征和结局。这项多中心回顾性队列研究纳入了2020年3月至2022年7月期间从巴西43家医院收治的实验室确诊的成年COVID-19患者。主要结局是住院死亡率。倾向评分分析根据年龄、性别、合并症数量和入院年份，将肾移植受者与对照组（慢性透析患者和非CKD患者，倾向评分对数的标准差在0.25以内）进行匹配。本研究共纳入555例患者：163例肾移植患者、146例慢性透析患者和249例非CKD患者（中位年龄57岁，女性占55.2%）。在临床结局方面，与肾移植受者相比，慢性透析患者急性心力衰竭的患病率更高。此外，两组患者的住院死亡率均较高，肾移植患者和慢性透析患者的住院死亡率分别为34.0%和28.1%。在比较肾移植患者和非CKD患者时，肾移植患者组的住院透析发生率更高（26.4%对8.8%，<0.001）、感染性休克发生率更高（24.1%对12.0%，=0.002）、死亡率更高（32.5%对23.3%，=0.039），并且在重症监护病房（ICU）的住院时间更长。在本研究中，与肾移植受者相比，慢性透析患者急性心力衰竭的患病率更高，而肾移植患者比非CKD患者有更高的并发症发生率，包括感染性休克、住院期间透析、住院死亡率以及在ICU的住院时间更长。
