2022年12月9日至10日在比利时拉胡尔佩多尔斯举行的比利时内科学会第26届年会上发表的摘要

IF 1.6 4区 医学 Q2 Medicine
Liselot Vandenbergen, Charline Leclercq, J. D. Greef, J. Yombi, H. Yildiz, Veerle Beckers, Shula Staessens, Sabine Allard, Rik Schots, L. Pothen, Ana Strezova, Javier Diez-Domingo, Kamal Al Shawafi, Juan Carlos Tinoco, Meng Shi, Paola Pirrotta, Angnes Mwakingwe-Omari, Florence Strubbe, Hernan Valdes-Socin, O. Calvete, Javier Benitez, Edouard Louis, P. Petrossians, S. Henrard, Nicola Trotta, Tim Coolen, Delphine Puttaert, J. Goffard, J. Vooren
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引用次数: 1

摘要

背景干重被定义为透析后最低耐受重量,在该重量下,低血容量或高血容量的体征或症状最小。达到干重是每个透析疗程的目标。这可以改善透析患者的血压控制,降低心血管风险。当分解代谢反应和炎症发生时,血液透析患者可能会经历可能与干物质减少有关的体重减轻。我们的目的是评估SARSCov-2感染对血液透析患者的影响,并分析与新冠肺炎大流行期间观察到的干重变化相关的因素。方法:在这项回顾性观察性单中心研究中,我们分析了2020年3月1日至2022年2月28日新冠肺炎大流行期间在Pole Hospitalier Jolimont接受血液透析的所有患者的临床特征。我们在诊断为严重急性呼吸系统综合征冠状病毒2型感染后第1天或随机分配的28天观察期的第1天以及2、3和4周后测定干重。我们比较了感染和未感染的患者,并检查了与严重急性呼吸系统综合征冠状病毒2型感染相关的临床特征以及与干重变化相关的临床特点。结果:在观察期内,162名血液透析患者中,47名患者感染了严重急性呼吸系统综合征冠状病毒2型。三名患者因在第一次透析前感染而被排除在外,另有十七名患者因数据缺失而被排除。两名患者被感染了两次,但我们认为第二次发作是相关的,因此进行了144次观察。干重变异比(干重变异除以第1天的干重)是一个连续的非正态分布变量,我们对此进行了Wilcoxon秩和检验和Student t检验。与未感染的患者相比,感染严重急性呼吸系统综合征冠状病毒2型的患者的干重变化更大:感染透析患者的平均干重变化率为-2,4+/-2,2%(SD),未感染患者为-0.6+/-2,0%(p<0.001);95%置信区间[7,17-66,85]。感染患者是否有症状没有发现差异(-2,6+/-2,2%与-2,3+/-2,3%;p=0.062)。感染患者和未感染患者的性别分布有显著差异(76%对52%的男性;p=0.008)。我们进行了Cochran-Mantel-Haenszel分层分析,并在控制了性别影响或混淆后,证实了干重损失与严重急性呼吸系统综合征冠状病毒2型感染之间的相关性。此外,干重在早期血液透析期间经常变化,也排除了透析时间短等偏差。事实上,在我们的人群中观察到的最短透析持续时间(不到2个月)和干重变化之间没有发现相关性。讨论:严重急性呼吸系统综合征冠状病毒2型感染与血液透析患者干重下降有关。怀疑严重急性呼吸系统综合征冠状病毒2型感染的系统影响,因为有症状和无症状感染的透析患者的干重变化非常相似。在我们的人群中,只有2名患者死于与严重急性呼吸系统综合征冠状病毒2型感染相关的并发症。适应干重可能是降低感染透析患者死亡率的主要因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Abstracts presented at the 26th Annual Congress of the Belgian Society of Internal Medicine, 9-10 December 2022, Dolce La Hulpe, La Hulpe, Belgium
Background Dry weight is defined as the lowest tolerated post-dialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Achieving dry weight is a goal for each dialysis session. That improves blood pressure control and reduces cardiovascular risk in dialysis patients. Haemodialysis patients may experience weight loss likely related to a reduction of dry mass when catabolic reactions and inflammation occur. Our aim was to assess the impact of SARSCov-2 infection on haemodialysis patients and analyse factors associated with dry weight variations observed during the COVID-19 pandemic. Method(s): In this retrospective observational single-centre study, we analysed the clinical characteristics of all patients undergoing haemodialysis at the Pole Hospitalier Jolimont during COVID-19 pandemic from 1 March 2020 to 28 February 2022. We determined dry weight at day 1 after diagnosis of SARSCov-2 infection or at day 1 of a randomly assigned 28-days observation period and at 2, 3 and 4 weeks later. We compared infected and uninfected patients and examined the clinical features associated with SARSCov-2 infection and those associated with changes in dry weight. Result(s): Within the observation period, among the 162 haemodialysis patients, 47 patients were infected with SARSCov-2. Three patients were excluded because they have been infected before the first dialysis session and seventeen others due to missing data. Two patients were infected twice but we considered the second episodes as relevant and had therefore 144 observations. Dry weight variation ratio (dry weight variation divided by dry weight at day 1) was a continuous non normally distributed variable for which we performed Wilcoxon rank sum tests and Student's t-tests. Dry weight variations were bigger in patients infected with SARSCov-2 compared to non-infected patients: the mean dry weight variation ratio was - 2,4 +/- 2,2% (SD) in the infected dialysis patients and - 0,6 +/- 2,0% in the uninfected patients (p < 0.001). A very strong association was found between SARSCov-2 infection and loss of dry weight (0,5 kg and more) with odds ratio = 21,89;95% CI [7,17-66,85]. No difference was found whether infected patients were symptomatic or not (-2,6 +/- 2,2% vs - 2,3 +/- 2,3%;p = 0,662). Infected patients and non-infected patients significantly differ by the sex distribution (76% vs 52% males;p = 0,008). We performed a Cochran-Mantel-Haenszel stratified analysis and confirmed the association between loss of dry weight and SARSCov-2 infection after controlling for effect modification or confounding by sex. Furthermore, dry weight often varies during early haemodialysis sessions and a bias such as a short dialysis duration was also ruled out. Indeed, no correlation was found between the shortest dialysis durations (less than 2 months) and the dry weight variations observed in our population. Discussion(s): SARSCov-2 infection is associated with decreases of dry weight in haemodialysis patients. Systemic effects of SARSCov-2 infection are suspected since dry weight changes are quite similar both in symptomatic and asymptomatic infected dialysis patients. Only 2 patients in our population died from complications related to SARSCov-2 infection. Adapting dry weight may be a major element in lowering mortality in infected dialysis patients.
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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