Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, Brazil.
Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.
Ann Med. 2024 Dec;56(1):2343890. doi: 10.1080/07853890.2024.2343890. Epub 2024 May 13.
The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear.
We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD ( = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD ( = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality.
Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10; = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69; = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96; < .001) and age (HR, 95%CI = 1.05, 1.01-1.08; = .008) were independent predictors of all-cause mortality in Covid-ESKD patients.
Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.
Covid-19 大流行影响了终末期肾病（ESKD）患者。透析参数在患有 Covid-19 的 ESKD 患者中是否具有预后价值尚不清楚。
我们回顾性评估了巴西四家血液透析机构中接受维持性门诊血液透析的 ESKD 患者的临床特征、血压（BP）和透析参数，这些患者患有（Covid-ESKD）和未患有（No-Covid-ESKD）Covid-19。Covid-ESKD（ = 107；54%女性；60.8 ± 17.7 岁）和 No-Covid-ESKD（ = 107；62%女性；58.4 ± 14.6 岁）组按日历时间匹配。在感染前、急性感染期和感染后计算平均 BP 和透析参数。主要结局是 Covid-19 住院和全因死亡率。
与感染前 1 周相比，Covid-ESKD 患者在急性疾病期间的透析内和透析后收缩压更高，透析前体重、透析后体重、超滤率和透析间体重增加更少，而 No-Covid-ESKD 患者没有观察到这些变化。在 286 天的随访（范围 276-591）后，Covid-ESKD 患者中有 18 例与 Covid-19 相关的住院治疗和 28 例死亡。多变量逻辑回归分析显示，从感染前 1 周到急性疾病，透析前收缩压升高（OR，95%CI = 1.06，1.02-1.10； = .004）和 Covid-19 疫苗接种（OR，95%CI = 0.16，0.04-0.69； = .014）与 Covid-ESKD 患者的住院治疗相关。多变量 Cox 回归分析显示，Covid-19 相关住院治疗（HR，95%CI = 5.17，2.07-12.96； < .001）和年龄（HR，95%CI = 1.05，1.01-1.08； = .008）是 Covid-ESKD 患者全因死亡率的独立预测因素。
急性 Covid-19 疾病与 ESKD 患者透析容量状态参数的变化有关。此外，急性 Covid-19 疾病期间透析前血压升高与 Covid-ESKD 患者的不良预后相关。
