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

封面

如何引用文章

全文:

详细

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.

作者简介

Mikhail Zubkin

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

编辑信件的主要联系方式.
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

俄罗斯联邦, Moscow

Nadiya 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

俄罗斯联邦, Moscow

Irina 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

俄罗斯联邦, Moscow

Anzhela Ushakova

Moscow City Clinical Hospital №52

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

зав. отд-нием гемодиализа ГБУЗ ГКБ №52

俄罗斯联邦, Moscow

Sergei Usatiuk

Moscow City Clinical Hospital №52

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

зав. нефрологическим отд-нием ГБУЗ ГКБ №52

俄罗斯联邦, Moscow

Rustam 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

俄罗斯联邦, Moscow

Ekaterina Diakova

Moscow City Clinical Hospital №52

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

врач нефрологического отд-ния ГБУЗ ГКБ №52

俄罗斯联邦, Moscow

Valeriy 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»

俄罗斯联邦, Moscow

Elizaveta 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»

俄罗斯联邦, Moscow

Natalia 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»

俄罗斯联邦, Moscow

Evgeniy 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»

俄罗斯联邦, Saint Petersburg

参考

  1. World Health Organization. Coronavirus disease (COVID-2019) situation reports. Available at: https://www.who.int/emergencies/diseases/novelcoronavirus-2019/situation-reports. Accessed: 16.03.2020.
  2. Томилина Н.А., Фролова Н.Ф., Артюхина Л.Ю., и др. COVID-19: связь с патологией почек. Нефрология и диализ. 2021;23(2):147-59 [Tomilina NA, Frolova NF, Artyukhina LYu. et al. Covid-19: relationship with kidney diseases. Nefrologiia i dializ. 2021;23(2):147-59 (in Russian)]. doi: 10.28996/2618-9801-2021-2-147-159.
  3. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. doi: 10.1001/jama.2020.2648
  4. Pei G, Zhang Z, Peng J, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. JASN. 2020(31):1157-65. doi: 10.1001/jama.2020.2648
  5. Ronco C, Reis T, Husain-Syed F. Management of Acute Kidney Injury in Patients With COVID-19. Lancet Respir Med. 2020;(8)7:738-42. doi: 10.1016/S2213-2600(20)30229-0
  6. Зелтынь-Абрамов Е.М., Белавина Н.И., Фролова Н.Ф, и др. Факторы риска неблагоприятного прогноза у пациентов на программном гемодиализе с COVID-19. Акцент на сердечно-сосудистую коморбидность (опыт одного центра). Нефрология и диализ. 2020;22:9-20 [Zeltyn-Abramov EM, Belavina NI, Frolova NF, et al. Risk factors of adverse prognosis in patients on maintenance hemodialysis with Covid-19. Focus on cardivascular comorbidity (single center experience). Nefrologiia i dializ. 2020;22:9-20 (in Russian)]. doi: 10.28996/2618-9801-2020-Special_Issue-9-20.
  7. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 8.1 (1.10.2020). Временные методические рекомендации. М.: Минздрав РФ, 2020 [Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19). Versiia 8.1 (1.10.2020). Vremennye metodicheskie rekomendatsii. Moscow: Minzdrav RF, 2020 (in Russian)].
  8. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33. doi: 10.1001/jama.2012.5669
  9. Hemmelgarn BR, Manns BJ, Quan H, Ghali WA. Adapting the Charlson Comorbidity Index for use in patients with ESRD. Am J Kidney Dis. 2003;42(1):125-32. doi: 10.1016/s0272-6386(03)00415-3
  10. Yi Y, Lagniton PNP, Ye S, et al. COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci. 2020;6(10):1753-66. doi: 10.7150/ijbs.45134. eCollection 2020
  11. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020;5(7):831-40. doi: 10.1001/jamacardio.2020.1286
  12. Scarpioni R, Manini A, Valsania T, et al. Covid-19 and its impact on nephropathic patients: the experience at Ospedale "Guglielmo da Saliceto" in Piacenza. G Ital Nefrol. 2020;37(2):1-5.
  13. Covid-19 Registro ERA-EDTA. Available at: https://www.era-edta.org/en/registry/covid-19. Accessed: 03.08.2020.
  14. Alberici F, Delbarba E, Manenti C, et al. Management of patients on dialysis and with kidney transplantation during the SARS-CoV-2 (COVID-19) pandemic in Brescia, Italy. Kidney Int Rep. 2020;5(5):580-5. doi: 10.1016/j.ekir.2020.04.001
  15. Ma Y, Diao B, Lv X, et al. 2019 novel coronavirus disease in hemodialysis (HD) patients: Report from one HD center in Wuhan China. MedRxiv. 2020. doi: 10.1101/2020.02.24.20027201
  16. Wang R, Liao C, He H, et al. COVID-19 in hemodialysis patients: a report of 5 cases. Am J Kidney Dis. 2020;76(1):141-6. doi: 10.1053/j.ajkd.2020.03.009
  17. Ugur M, Ebru HAS, Ozlem KA, et al. Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients: A Single-Center Experience. Exp Clin Transplant. 2020;18(3):275-83. doi: 10.6002/ect.2020.0194
  18. Clarke C, Prendecki M, Dhutia A, et al. High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening. J Am Soc Nephrol. 2020;31(9):1969-75. doi: 10.1681/ASN.2020060827
  19. Зубкин М.Л., Шило В.Ю., Новикова Л.И., и др. Частота инфицирования SARS-CoV-2 среди больных, получающих лечение программным гемодиализом. Инфекционные болезни: новости, мнения, обучение. 2021 (в печати) [Zubkin ML, Shilo VIu, Novikova LI, et al. Frequency of SARS-CoV-2 infection in hemodialysis patients.Нужен перевод. Infektsionnye bolezni: novosti, mneniia, obuchenie. 2021;10(3):23-32 (in Russian)]. doi: 10.33029/2305-3496-2021-10-3-23-32
  20. Фролова Н.Ф., Ким И.Г., Ушакова А.И., и др. COVID-19 у больных, получающих лечение программным гемодиализом. Инфекционные болезни: новости, мнения, обучение. 2021;10(1):14-23 [Frolova NF, Kim IG, Ushakova AI, et al. COVID-19 in hemodialysis patients. Infektsionnye bolezni: novosti, mneniia, obuchenie. 2021;10(1):14-23 (in Russian)]. doi: 10.33029/2305-3496-2021-10-1-14-23
  21. Goicoechea M, Camara LAS, Macías N, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020;98(1):27-34. doi: 10.1016/j.kint.2020.04.031
  22. Valeri AM, Robbins-Juarez SY, Stevens JS, et al. Presentation and Outcomes of Patients with ESKD and COVID-19. J Am Soc Nephrol. 2020;31(7):1409-15. doi: 10.1681/ASN.2020040470
  23. Ng JH, Hirsch JS, Wanchoo R, et al. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19. Kidney Int. 2020;98(6):1530-9. doi: 10.1016/j.kint.2020.07.030
  24. Grasselli G, Zangrillo A, Zanella A, et al. COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. doi: 10.1001/jama.2020.5394
  25. Fisher M, Yunes M, Mokrzycki MH, et al. Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York. Kidney 360. 2020;1(8):755-62. doi: 10.34067/KID.0003672020
  26. Xiong F, Tang H, Liu L, et al. Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China. J Am Soc Nephrol. 2020;31(7):1387-97. doi: 10.1681/ASN.2020030354
  27. Corbett RW, Blakey S, Nitsch D, et al. Epidemiology of COVID-19 in an Urban Dialysis Center. J Am Soc Nephrol. 2020;31(8):1815-23. doi: 10.1681/ASN.2020040534
  28. Manganaro M, Baldovino S. First considerations on the SARS CoV 2 epidemic in the Dialysis Units of Piedmont and Aosta Valley, Northern Italy. J Nephrol. 2020;33(3):393-5. doi: 10.1007/s40620-020-00732-1
  29. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14(4):303-10. doi: 10.1016/j.dsx.2020.04.004
  30. Scheen AJ. Obesity and risk of severe COVID-19. Rev Med Suisse. 2020;16(695):1115-9.
  31. Li X, Wang L, Yan S, et al. Clinical characteristics of 25 death cases with COVID-19: a retrospective review of medical records in a single medical center, Wuhan, China. Int J Infect Dis. 2020;94:128-32. doi: 10.1016/j.ijid.2020.03.053
  32. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3
  33. Liu W, Zhou P, Chen K, et al. Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis. CMAJ. 2020;192(27):734-44. doi: 10.1503/cmaj.200647
  34. Hernandez AV, Roman YM, Pasupuleti V, et al. Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19. Ann Intern Med. 2020;173(4):287-96. doi: 10.7326/L20-0945
  35. Kim MS, An MH, Kim WJ, Hwang TH. Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: a systematic review and network meta-analysis. PLoS Med. 2020;17(12):e1003501. doi: 10.1371/journal.pmed.1003501
  36. Jorgensen SCJ, Tse CLY, Burry L, Dresser LD. Baricitinib: A review of pharmacology, safety and emerging clinical experience in COVID-19. Pharmacotherapy. 2020;40(8):843-56. doi: 10.1002/phar.2438
  37. Hariyanto TI, Hardyson W, Kurniawan A. Efficacy and Safety of Tocilizumab for Coronavirus Disease 2019 (Covid-19) Patients: A Systematic Review and Meta-analysis. Drug Res (Stuttg). 2021;71(5):265-74. doi: 10.1055/a-1336-2371
  38. Alunno A, Najm A, Mariette X, et al. Immunomodulatory therapies for SARS-CoV-2 infection: a systematic literature review to inform EULAR points to consider. Ann Rheum Dis. 2021;80(6):803-15. doi: 10.1136/annrheumdis-2020-219725
  39. Tleyjeh IM, Kashour Z, Damlaj M, et al. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(2):215-27. doi: 10.1016/j.cmi.2020.10.036.

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Pandemic’s first year: transformation of treatment approaches at different stages.

下载 (255KB)
索引源数据
3. Fig. 2. Pandemic’s first year: lung lesion indicators and frequency of mechanical ventilation at different stages.

下载 (101KB)
索引源数据

版权所有 © Consilium Medicum, 2021

Creative Commons License
此作品已接受知识共享署名-非商业性使用-相同方式共享 4.0国际许可协议的许可。
 
 


##common.cookie##