新冠疫情对维持性血液透析患者并发症影响的单中心分析

Single⁃center analysis of the effect of COVID⁃19 epidemic on complications in maintenance hemodialysis patients

目的:2022年上海经历了两轮新冠疫情,本研究旨在了解维持性血液透析(MHD)患者在不同疫情阶段的并发症控制情况。方法:回顾性分析上海交通大学医学院附属瑞金医院血液净化中心2022年1月至2023年1月MHD患者的实验室检查结果,比较第1轮疫情前(2022年1月)、第1轮疫情后(2022年7月)、第2轮疫情前(2022年10月)、第2轮疫情后(2023年1月)患者慢性肾脏病(CKD)并发症达标情况。结果:共纳入MHD患者259例。第1轮疫情期间本中心患者感染率为6.7%,共有5例患者死亡,死因皆与新冠感染无关;第2轮疫情期间患者感染率为78.5%,共有15例患者死亡,其中9例与新冠感染相关。四个阶段患者整体血红蛋白达标率分别为45.1%、39.0%、52.0%、36.2%,第2轮疫情前达标率最高(P<0.05);铁代谢达标率分别为19.4%、15.3%、18.3%、24.4%;白蛋白达标率分别为66.4%、61.9%、77.0%、56.9%,第2轮疫情前与其他阶段有统计学差异(P<0.05);血钙达标率分别为69.2%、70.7%、70.7%、54.9%,第2轮疫情后与其他阶段有统计学差异(P<0.05);血磷达标率分别为34.0%、32.5%、38.2%、32.9%,各阶段前后没有统计学差异;第2轮疫情前后全段甲状旁腺激素(iPTH)达标率分别为28.4%、23.3%(P=0.232)。各阶段前后血清肌酐、尿素氮、血钾水平均无统计学差异。结论:新冠不同疫情防控措施与流行毒株,所造成的感染率及病情严重程度不同,均可影响CKD并发症指标的达标率。疫情期间应特别注意对患者贫血及营养状况的关注。

Objective:Shanghai has experienced two waves of the COVID⁃19 epidemic in 2022.The aim of our study was to understand the difference of the laboratory results in maintenance hemodialysis patients at different stages of the epidemic.Methodology:The laboratory tests of maintenance hemodialysis(MHD)patients from January 2022 to January 2023 at the Blood Purification Center of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed,and the complications of chronic kidney disease in each stage were compared:before the first round of the epidemic(January 2022),after the first round of the epidemic(July 2022),before the second round of the epidemic(October 2022),and after the second round of the epidemic(January 2023).Results:259 MHD patients were enrolled in this study.During the first round of the epidemic,the infection rate of patients in our center was 6.7%,and a total of 5 patients died,all of which were unrelated to COVID⁃19 infection.During the second round of the epidemic,the infection rate was 78.5%,and a total of 15 patients died,of which 9 were related to COVID⁃19 infection.The overall hemoglobin compliance rates of patients in the four stages were 45.1%,39.0%,52.0%and 36.2%.And the highest compliance rate was in stage 3(October 2022),which was statistically different from other stages(P<0.05).The rates of iron metabolism compliance were 19.4%,15.3%,18.3%and 24.4%,respectively.The albumin compliance rates were 66.4%,61.9%,77.0%and 56.9%,respectively,and there were significant differences between the stage 3 and other stages(P<0.05).The calcium compliance rates were 69.2%,70.7%,70.7%and 54.9%,respectively,and there were significant differences between the stage 4 and other stages(P<0.05).The phosphorus compliance rates were 34.0%,32.5%,38.2%and 32.9%,respectively,and there were no significant differences between the stages.The compliance rates of iPTH during the stage 3 and the stage 4 were 28.4%and 23.3%(P=0.232),respectively.There were no significant differences in Scr,BUN,or potassium levels between different stages.Conclusion:Different epidemic prevention and control measures and different COVID⁃19 variant bring different infection rates and disease severity,but the decrease of CKD complication rate will certainly happen.During the epidemic,special attention should be paid to the correction of anaemia and nutritional status of patients.Patients in the intermission period of the epidemic had the highest compliance rate.