西班牙 COVID-19 住院期间急性肾衰竭患者的特征:肾替代疗法和死亡率。数据来自 FRA-COVID SEN 登记处。

IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Nefrologia Pub Date : 2024-07-01 DOI:10.1016/j.nefro.2023.03.008
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引用次数: 0

摘要

背景和目的急性肾损伤(AKI)在 COVID-19 住院患者中很常见,并与预后恶化有关。西班牙肾脏病学会创建了 AKI-COVID 注册表,以描述西班牙医院中因 COVID-19 而入院并发生 AKI 的人群的特征。材料和方法在一项回顾性研究中,我们分析了 AKI-COVID 登记处的数据,其中包括 2020 年 5 月至 2021 年 11 月期间在 30 家西班牙医院住院的患者。我们记录了临床和人口统计学变量、与 COVID-19 和 AKI 严重程度相关的因素以及生存数据。结果 记录了 730 名患者的数据。71.9%的患者为男性,平均年龄为70岁(60-78岁),70.1%患有高血压,32.9%患有糖尿病,33.3%患有心血管疾病,23.9%患有某种程度的慢性肾病(CKD)。从出现 COVID-19 症状到出现 AKI(37.1% KDIGO I,18.3% KDIGO II,44.6% KDIGO III)的中位时间为 6 天(4-10 天)。共有 235 名(33.9%)患者需要接受 RRT 治疗:155 名患者接受持续肾脏替代治疗,89 名患者接受隔日透析,36 名患者接受每日透析,24 名患者接受延长血液透析,17 名患者接受血液滤过。吸烟习惯(OR 3.41)、通气支持(OR 20.2)、肌酐最高值(OR 2.41)和 AKI 发病时间(OR 1.13)是需要 RRT 的预测因素;年龄是一个保护因素(0.95)。无 RRT 组的特点是年龄较大、AKI 病情较轻、肾损伤发生时间和恢复时间较短(P < 0.05)。38.6%的患者在住院期间死亡;在死亡组中,严重的 AKI 和 RRT 更为常见。在多变量分析中,年龄(OR 1.03)、既往慢性肾脏病(OR 2.21)、肺炎(OR 2.89)、呼吸支持(OR 3.34)和 RRT(OR 2.28)是预测死亡率的因素,而长期使用 ARBs 治疗被认为是一个保护因素(OR 0.55)。我们定义了两种不同的临床模式:一种是早发性 AKI,年龄较大的患者可在几天内缓解,无需进行 RRT;另一种是更严重的模式,更需要进行 RRT,且发病较晚,这与感染性疾病的严重程度有关。感染的严重程度、年龄和入院前是否患有慢性肾功能衰竭被认为是这些患者死亡的风险因素。此外,长期接受抗逆转录酶抑制剂治疗被认为是死亡率的保护因素。
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Caracterización de la población con fracaso renal agudo durante la hospitalización por COVID-19 en España: tratamiento renal sustitutivo y mortalidad. Datos del Registro FRA-COVID SEN

Background and objectives

Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed.

Material and method

In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality.

Results

Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60–78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.

The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4–10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).

Conclusions

Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.

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来源期刊
Nefrologia
Nefrologia 医学-泌尿学与肾脏学
CiteScore
3.40
自引率
7.70%
发文量
148
审稿时长
47 days
期刊介绍: Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.
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