The Characteristics, Dynamics, and the Risk of Death in COVID-19 Positive Dialysis Patients in London, UK.

Autor:	Kular D; Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom., Chis Ster I; Institute of Infection and Immunity, St George's University of London, London, United Kingdom., Sarnowski A; Renal and Transplantation Unit, St George's University Hospital National Health Service Foundation Trust, London, United Kingdom., Lioudaki E; Renal Unit, King's College Hospital National Health Service Foundation Trust, London, United Kingdom., Braide-Azikiwe DCB; Renal Unit, King's College Hospital National Health Service Foundation Trust, London, United Kingdom., Ford ML; Renal Unit, King's College Hospital National Health Service Foundation Trust, London, United Kingdom., Makanjuola D; Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom., Rankin A; Renal Unit, King's College Hospital National Health Service Foundation Trust, London, United Kingdom., Cairns H; Renal Unit, King's College Hospital National Health Service Foundation Trust, London, United Kingdom., Popoola J; Renal and Transplantation Unit, St George's University Hospital National Health Service Foundation Trust, London, United Kingdom.; Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom., Cole N; Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom., Phanish M; Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom., Hull R; Renal and Transplantation Unit, St George's University Hospital National Health Service Foundation Trust, London, United Kingdom., Swift PA; Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals National Health Service Trust, Epsom, United Kingdom., Banerjee D; Renal and Transplantation Unit, St George's University Hospital National Health Service Foundation Trust, London, United Kingdom.; Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Kidney360 [Kidney360] 2020 Sep 10; Vol. 1 (11), pp. 1226-1243. Date of Electronic Publication: 2020 Sep 10 (Print Publication: 2020).
DOI:	10.34067/KID.0004502020
Abstrakt:	Background: Patients on dialysis with frequent comorbidities, advanced age, and frailty, who visit treatment facilities frequently, are perhaps more prone to SARS-CoV-2 infection and related death-the risk factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in patients on dialysis infected with SARS-CoV-2. Methods: Data on 224 patients on hemodialysis between February 29, 2020 and May 15, 2020 with confirmed SARS-CoV-2 were analyzed for outcomes and potential risk factors for death, using a competing risk-regression model assessed by subdistribution hazards ratio (SHR). Results: Crude data analyses suggest an overall case-fatality ratio of 23% (95% CI, 17% to 28%) overall, but that varies across age groups from 11% (95% CI, 0.9% to 9.2%) in patients ≤50 years old and 32% (95% CI, 17% to 48%) in patients >80 years; with 60% of deaths occurring in the first 15 days and 80% within 21 days, indicating a rapid deterioration toward death after admission. Almost 90% of surviving patients were discharged within 28 days. Death was more likely than hospital discharge in patients who were more frail (WHO performance status, 3-4; SHR, 2.16 [95% CI, 1.25 to 3.74]; P =0.006), had ischemic heart disease (SHR, 2.28 [95% CI, 1.32 to 3.94]; P =0.003), cerebrovascular disease (SHR, 2.11 [95% CI, 1.20 to 3.72]; P =0.01), smoking history (SHR, 2.69 [95% CI, 1.33 to 5.45]; P =0.006), patients who were hospitalized (SHR, 10.26 [95% CI, 3.10 to 33.94]; P <0.001), and patients with high CRP (SHR, 1.35 [95% CI, 1.10 to 1.67]) and a high neutrophil:lymphocyte ratio (SHR, 1.03 [95% CI, 1.01 to 1.04], P <0.001). Our data did not support differences in the risk of death associated with sex, ethnicity, dialysis vintage, or other comorbidities. However, comparison with the entire dialysis population attending these hospitals, in which 13% were affected, revealed that patients who were non-White (62% versus 52% in all patients, P =0.001) and those with diabetes (54% versus 22%, P <0.001) were disproportionately affected. Conclusions: This report discusses the outcomes of a large cohort of patients on dialysis. We found SARS-CoV-2 infection affected more patients with diabetes and those who were non-White, with a high case-fatality ratio, which increased significantly with age, frailty, smoking, increasing CRP, and neutrophil:lymphocyte ratio at presentation. Competing Interests: A. Sarnowski reports receiving grants from KIDNEYcon, during the conduct of the study; and reports holding shares in Baxter and Fresenius, outside the submitted work. All remaining authors have nothing to disclose. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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