Смертність у хворих на ХХН VГД з постковідним синдромом: багатоцентрове, проспективне, когортне дослідження

Mykola Kolesnyk; Natalia Stepanova; Tetyana Ostapenko; Lyudmyla Snisar; Andriy  Rysev; Iryna Shifris

doi:10.31450/ukrjnd.3(83).2024.09

Mykola Kolesnyk State Institution “O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0001-6658-3729
Natalia Stepanova State Institution “O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-1070-3602
Tetyana Ostapenko Dialysis Medical Center LLC “Nephrocenter”, Zaporizhzhia, Ukraine
Lyudmyla Snisar Dialysis Medical Center LLC “Nephrocenter”, Kyiv, Ukraine https://orcid.org/0000-0002-2968-0885
Andriy Rysev Dialysis Medical Center LLC “Link-Medital”, Odesa, Ukraine
Iryna Shifris State Institution “O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-9413-7301

DOI: https://doi.org/10.31450/ukrjnd.3(83).2024.09

Keywords: hemodialysis, COVID-19, post-COVID syndrome, mortality, risk factors.

Abstract

End-stage kidney disease requiring hemodialysis (HD) is a critical global health issue exacerbated by the COVID-19 pandemic. While post-COVID syndrome (PCS) is known to affect HD patients' quality of life, its impact on long-term mortality remains unclear. This study aims to analyze two-year post-COVID mortality in HD patients and identify its clinical determinants.

Methods. This multicenter, prospective real-world cohort study included HD patients from four dialysis centers in Ukraine who had survived COVID-19 up to March 2022. Data collected included demographics, clinical and laboratory parameters, COVID-19 severity, and PCS presence three months after infection. The primary endpoints were overall two-year mortality and PCS-associated mortality.

Results. Out of 465 HD patients, 353 met the inclusion criteria. PCS was diagnosed in 222 patients (62.9%), which was associated with male gender, older age, diabetes, temporary vascular access, higher Charlson comorbidity Index, lower Kt/V, lower hemoglobin and albumin levels, higher CONUT scores, and higher CRP levels. Over two years, 38 patients (11.4%) died, with cardiovascular events (42.2%) and infections (21.1%) being the leading causes. PCS Multivariable Cox regression analysis identified older age (OR 1.32, 95% CI 1.03; 1.66), dialysis vintage (OR 1.86, 95% CI 1.77; 1.97), diabetes (OR 3.57, 95% CI 1.81; 7.06), higher comorbidity (OR 4.22, 95% CI 2.11; 7.82), lower nutritional status (OR 1.66, 95% CI 1.08; 12.3), temporary vascular access (OR 1.88, 95% CI 1.16; 3.86), high blood pressure (OR 1.37, 95% CI 1.03; 1.82) and C-reactive protein level (OR 1.68, 95% CI 1.49; 1.95), and severe COVID-19 requiring hospitalization (OR 5.7, 95% CI 3.73; 7.89) as independent mortality predictors. Conversely, target levels of hemoglobin (OR 0.87, 95% CI 0.66; 0.99) and Kt/V (OR 0.74, 95% CI 0.68; 0.96), and COVID-19 vaccination (OR 0.17, 95% CI 0.05; 0.61) significantly decreased the probability of mortality. PCS did not significantly impact the long-term survival of HD patients post-COVID.

Conclusions. Two-year mortality in HD patients with PCS is driven by a combination of demographic and clinical-laboratory factors, such as older age, prolonged dialysis treatment, comorbidities, protein-energy malnutrition, temporary vascular access, inadequate dialysis dose, low hemoglobin levels, chronic inflammation, uncontrolled blood pressure, negative vaccination status, and severe acute COVID-19 with oxygen support. Vaccination and maintenance of target monitoring parameters after COVID-19 are crucial for improving survival in this patient population.