COVID-19患者延迟血液透析:病例系列及文献综述

Clinical Nephrology. Case Studies Pub Date : 2021-03-11 eCollection Date: 2021-01-01 DOI:10.5414/CNCS110240
Michael Connerney, Yasar Sattar, Hiba Rauf, Sahil Mamtani, Waqas Ullah, Nara Michaelson, Umaima Dhamrah, Naman Lal, Sharaad Latchana, Aaron Saul Stern
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引用次数: 0

摘要

背景:COVID-19患者肾损伤发生率增加。然而,对终末期肾脏疾病(ESRD)血液透析(HD)患者的COVID-19易感性和结局知之甚少。血管紧张素转换酶2 (ACE-2)与SARS-CoV-2结合降低和血管紧张素II (Ang-II)活性升高被认为是COVID-19肾脏病理生理的机制。材料和方法:在这个病例系列中,我们分析了3例延迟接受常规HD治疗的ESRD患者的数据。需氧量降低,高钾血症解决,正常体液状态作为出院的基础。结果:临床表现为发热、呼吸困难、干咳。实验室标志物是COVID-19的特征,如淋巴细胞减少、d -二聚体、c反应蛋白(CRP)和白细胞介素6 (IL-6)升高。我们报告的所有3例患者在入院时都需要紧急HD。然而,在我们的病例系列中,我们没有报告死亡病例,并且我们的患者没有需要气管插管的严重病程。我们回顾了COVID-19的病理生理学,以及HD患者ESRD如何特别具有感染风险。结论:新发肾衰竭或ESRD后遗症,如高钾血症、尿毒症性脑病和体液超载,可因COVID-19感染延迟接受HD而加剧。COVID-19的直接感染和这次大流行给医疗保健后勤带来的挑战都对HD的ESRD患者构成了独特的威胁。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Delayed hemodialysis in COVID-19: Case series with literature review.

Delayed hemodialysis in COVID-19: Case series with literature review.

Background: Increased incidence of kidney injury has been seen in patients with COVID-19. However, less is known about COVID-19 susceptibility and outcomes in end-stage renal disease (ESRD) patients on hemodialysis (HD). Reduced angiotensin-converting enzyme 2 (ACE-2) from SARS-CoV-2 binding and increased angiotensin II (Ang-II) activity have been suggested as mechanisms for COVID-19 renal pathophysiology.

Materials and methods: In this case series, we analyzed the data of 3 patients with ESRD who had a delay in receiving their regular HD. Reduced oxygen requirement, resolved hyperkalemia, and normalized fluid status were used for the basis of discharge.

Results: Presenting symptoms included fever, dyspnea, and dry cough. Laboratory markers were characteristic for COVID-19, such as lymphopenia, elevated D-dimer, C-reactive protein (CRP), and interleukin 6 (IL-6). All 3 of our reported patients required urgent HD upon admission. However, we report no fatalities in our case series, and our patients did not have a severe course of illness requiring endotracheal intubation. We reviewed COVID-19 pathophysiology and how patients with ESRD on HD may be particularly at risk for infection.

Conclusion: New renal failure or ESRD sequelae, such as hyperkalemia, uremic encephalopathy, and fluid overload, can be exacerbated by a delay in receiving HD due to COVID-19 infection. Both direct COVID-19 infection and the challenges this pandemic creates to health care logistics present unique threats to ESRD patients on HD.

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