COVID-19 in haemodialysis patients: result analysis of the first year of the pandemic
- Authors: Zubkin M.L.1,2,3, Frolova N.F.1, Kim I.G.1,2, Ushakova A.I.1, Usatiuk S.S.1, Iskhakov R.T.1, Diakova E.N.1, Chervinko V.I.3, Volodina E.V.2, Tomilina N.A.4, Kryukov E.V.5
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Affiliations:
- Moscow City Clinical Hospital №52
- Gabrichevsky Research Institute of Epidemiology and Microbiology
- Branch of the Kirov Military Medical Academy
- Yevdokimov Moscow State University of Medicine and Dentistry
- Kirov Military Medical Academy
- Issue: Vol 93, No 11 (2021)
- Pages: 1325-1333
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/99604
- DOI: https://doi.org/10.26442/00403660.2021.11.201215
- ID: 99604
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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.
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##article.viewOnOriginalSite##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, MoscowNadiya 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, MoscowIrina 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, MoscowAnzhela 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, MoscowSergei 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, MoscowRustam 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, MoscowEkaterina 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, MoscowValeriy 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, MoscowElizaveta 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, MoscowNatalia 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, MoscowEvgeniy 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 PetersburgReferences
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