COVID-19 in haemodialysis patients: result analysis of the first year of the pandemic

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Abstract

Background. Present concepts of the novel coronavirus infection prognosis in haemodialysis (HD) patients are rather controversial. There is little information on therapy efficiency and safety in such patients. We studied COVID-19 course specifics, prognostic factors associated with fatal outcomes, therapy efficiency and its transformation at different stages of the pandemic first year.

Materials and methods. Single-centre retrospective uncontrolled study included 653 COVID-19 HD-patients treated at Moscow City Nephrology Centre from April 1 to December 31, 2020.

Results. This period mortality rate was 21.0%. Independent predictors of COVID-19 unfavourable outcome in HD patients were pulmonary lesion extension (CT grades 3–4), high comorbidity index, and mechanical ventilation. Approaches to COVID-19 treatment modified significantly at different periods. Immunomodulatory drugs (monoclonal antibodies to IL-6, corticosteroids) were used largely at later stages. With tocilizumab administration, mortality was 15.1%, tocilizumab together with dexamethasone – 13.3%; without them – 37.8% (р<0,001). Tocilizumab administration in the first 3 days after hospitalization of patients with CT grades 1–2 was associated with more favourable outcomes: 1 out of 29 died vs 6 out of 20 (tocilizumab administered at later periods); p<0.04. There was no significant difference in death frequency in patients with CT grades 3–4 depending on tocilizumab administration time.

Conclusion. COVID-19 in HD patients can manifest in a severe course with unfavourable outcome. It is urgent to identify reliable disease outcome predictors and develop efficient treatment in this population.

About the authors

Mikhail L. Zubkin

Moscow City Clinical Hospital №52; Gabrichevsky Research Institute of Epidemiology and Microbiology; Branch of the Kirov Military Medical Academy

Author for correspondence.
Email: m-zubkin@yandex.ru
ORCID iD: 0000-0001-5271-1902

д-р мед. наук, проф., рук. клинико-диагностического отд. ФБУН «МНИИЭМ им. Г.Н. Габричевского», проф. каф. терапии и неотложных состояний филиала ФГБВОУ ВО «ВМА им. С.М. Кирова», консультант нефрологического отд-ния ГБУЗ ГКБ №52

Russian Federation, Moscow

Nadiya F. Frolova

Moscow City Clinical Hospital №52

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-6086-5220

канд. мед. наук, зам. глав. врача по нефрологической помощи ГБУЗ ГКБ №52

Russian Federation, Moscow

Irina G. Kim

Moscow City Clinical Hospital №52; Gabrichevsky Research Institute of Epidemiology and Microbiology

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0001-5555-9993

канд. мед. наук, вед. науч. сотр. ФБУН «МНИИЭМ им. Г.Н. Габричевского», врач-нефролог КДНО ГБУЗ ГКБ №52

Russian Federation, Moscow

Anzhela I. Ushakova

Moscow City Clinical Hospital №52

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-3959-6281

зав. отд-нием гемодиализа ГБУЗ ГКБ №52

Russian Federation, Moscow

Sergei S. Usatiuk

Moscow City Clinical Hospital №52

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-8742-3860

зав. нефрологическим отд-нием ГБУЗ ГКБ №52

Russian Federation, Moscow

Rustam T. Iskhakov

Moscow City Clinical Hospital №52

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0003-2850-4465

зав. отд-нием реанимации и интенсивной терапии для больных нефрологического профиля ГБУЗ ГКБ №52

Russian Federation, Moscow

Ekaterina N. Diakova

Moscow City Clinical Hospital №52

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0003-1599-1639

врач нефрологического отд-ния ГБУЗ ГКБ №52

Russian Federation, Moscow

Valeriy I. Chervinko

Branch of the Kirov Military Medical Academy

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0003-1051-2897

канд. мед. наук, доц., доц. каф. терапии неотложных состояний филиала ФГБВОУ ВО «ВМА им. С.М. Кирова»

Russian Federation, Moscow

Elizaveta V. Volodina

Gabrichevsky Research Institute of Epidemiology and Microbiology

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-3951-0097

науч. сотр. ФБУН «МНИИЭМ им. Г.Н. Габричевского»

Russian Federation, Moscow

Natalia A. Tomilina

Yevdokimov Moscow State University of Medicine and Dentistry

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-3603-8524

д-р мед. наук, проф., зав. каф. нефрологии фак-та дополнительного профессионального образования ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Evgeniy V. Kryukov

Kirov Military Medical Academy

Email: m-zubkin@yandex.ru
ORCID iD: 0000-0002-8396-1936

чл.-кор. РАН, д-р мед. наук, проф., начальник ФГБВОУ ВО «ВМА им. С.М. Кирова»

Russian Federation, Saint Petersburg

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2. Fig. 1. Pandemic’s first year: transformation of treatment approaches at different stages.

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3. Fig. 2. Pandemic’s first year: lung lesion indicators and frequency of mechanical ventilation at different stages.

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