Jaques David A, Hoessly Linard, Guidotti Rebecca, Koller Michael, Ponte Belen, Ambuehl Patrice
Department of Medicine, Division of Nephology and Hypertension, Geneva University Hospitals, Geneva, Switzerland.
Department of Circulation, Thorax and Transplantation, Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
Clin Kidney J. 2024 Oct 29;17(12):sfae322. doi: 10.1093/ckj/sfae322. eCollection 2024 Dec.
While SARS-CoV-2 infection has direct obvious consequences on patients undergoing dialysis, the COVID-19 pandemic also had an indirect impact on health systems. Therefore, we aimed to determine whether the COVID-19 era itself was associated with adverse consequences in the Swiss dialysis population as compared to the pre-COVID-19 era, while accounting for direct impact of SARS-CoV-2 infection.
We retrospectively included all patients recorded in the Swiss dialysis registry from January 2014 to December 2022. The pre-COVID-19 era and the COVID-19 era were defined based on the cut-off date of January 2020. Cox proportional hazard model was used with all-cause mortality as the primary outcome.
The cohort consisted of 7837 patients from 97 dialysis centres. Median age was 68.6 years with 66.1% men. Crude mortality rates were 11.6% (11.0% to 12.2%) and 14.2% (13.4% to 14.9%) person-years for the pre-COVID-19 era and the COVID-19 era, respectively. In multivariable analysis, SARS-CoV-2 infection was associated with an increased risk of mortality (HR 4.26, 95% CI 3.65 to 4.97, < .001) while the COVID-19 era itself was not (HR 0.98, 95% CI 0.88 to 1.08, = .687).
The COVID-19 era was not associated with an excess of mortality in the Swiss dialysis population as compared to the pre-COVID-19 era when accounting for the direct effect of SARS-CoV-2 infection. This suggests that control measures established during the pandemic did not have a negative impact on dialysis patients at the national level. These results could inform health policy makers in the eventuality of future pandemics.
虽然严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染对接受透析的患者有直接明显的影响，但2019冠状病毒病（COVID-19）大流行也对卫生系统产生了间接影响。因此，我们旨在确定与COVID-19大流行前时代相比，COVID-19时代本身是否与瑞士透析人群的不良后果相关，同时考虑SARS-CoV-2感染的直接影响。
我们回顾性纳入了2014年1月至2022年12月瑞士透析登记处记录的所有患者。COVID-19大流行前时代和COVID-19时代根据2020年1月的截止日期定义。以全因死亡率作为主要结局，使用Cox比例风险模型。
该队列由来自97个透析中心的7837名患者组成。中位年龄为68.6岁，男性占66.1%。COVID-19大流行前时代和COVID-19时代的粗死亡率分别为11.6%（11.0%至12.2%）和14.2%（13.4%至14.9%）人年。在多变量分析中，SARS-CoV-2感染与死亡风险增加相关（风险比4.26，95%置信区间3.65至4.97，P<0.001），而COVID-19时代本身则不然（风险比0.98，95%置信区间0.88至1.08，P = 0.687）。
在考虑SARS-CoV-2感染的直接影响时，与COVID-19大流行前时代相比，COVID-19时代与瑞士透析人群的死亡率过高无关。这表明大流行期间制定的控制措施在国家层面上对透析患者没有负面影响。这些结果可为未来可能发生的大流行情况下的卫生政策制定者提供参考。
