Особливості перебігу COVID-19 у пацієнтів з хронічною хворобою нирок, які отримують замісну ниркову терапію

Abstract

Patients with chronic kidney disease stage 5 belong to the group of patients with the highest risk of complicated course of COVID-19. The purpose of the study was to study the prevalence and clinical and laboratory features of the COVID-19 infection among patients with end-stage of chronic kidney disease who receive renal replacement therapy. Materials and methods. The study included 172 patients with chronic kidney disease stage 5, who were receiving renal replacement therapy and who were diagnosed with COVID-19 for the period from April 2020 to April 2021. According to the type of renal replacement therapy all patients were divided into 3 groups: group 1 – 98 (56.9%) patients who received hemodialysis, group 2 – 60 (34.8%) patients who were on peritoneal dialysis, group 3 – 14 (8.1%) patients with kidney transplantation. The main clinical and laboratory parameters that characterize the course of the COVID-19 infection such as fever, diarrhea, anosmia, the percentage of oxygen saturation, the percentage of lung damage, levels of total protein, albumin, C-reactive protein, urea, creatinine, D-dimer, hemoglobin, leukocytes, platelets were evaluated. Results and discussion. The COVID-19 infection was diagnosed in 172 (38.2%) patients, the vast majority of whom – 110 (63.9%) patients were women with a mean age of 47.4±4.6 years. The analysis of clinical and laboratory parameters revealed the most severe course of the disease in patients with a kidney transplant and in patients who were on hemodialysis. In the group of renal transplant recipients there was a significant increase in the level of D-dimer, as well as a higher percentage of lung damage, compared with the average values of these indicators among patients on hemodialysis and peritoneal dialysis, but mortality in this group was 13.3% and was significantly lower than in the group of hemodialysis patients – 27.5%. It should be noted that in patients on renal replacement therapy by the method of hemodialysis, the adequacy of dialysis therapy was insufficient, which led to a more pronounced overall inflammatory response, which was characterized by the highest level of C-reactive protein (64.4±5.1 mg/l), compared with patients in the other study groups. The course of the disease in patients on hemodialysis was also complicated by anemia. In patients on renal replacement therapy by peritoneal dialysis, the COVID-19 infection was characterized by a mild course, with the lowest percentage of lung damage (22.0±2.8%) and fatalities (11.6%). Conclusion. According to our study, the incidence of COVID-19 among patients receiving renal replacement therapy is 38.2%. A more severe course of the disease was registered in the group of patients with a kidney transplant, due to the nature of comorbid pathology, as well as immunosuppressive therapy. The data obtained allow us to consider patients with a transplanted kidney as a risk group for severe COVID-19 infection