• Internal medicine · Sep 2024

    Clinical Course and Factors Correlated with Severe Morbidity and Mortality in Patients with Coronavirus Disease 2019 Undergoing Maintenance Dialysis in Kanagawa, Japan.

    • Kohei Ishiga, Hiromichi Wakui, Kengo Azushima, Tomohiko Kanaoka, Daisuke Kanai, Ryu Kobayashi, Sho Kinguchi, Naohito Okami, Tatsuya Haze, Takehisa Iwano, Masashi Sakai, Kohji Ohki, Jin Oshikawa, Toshiharu Kokuho, Masaaki Hanaoka, Hiroshi Mitsuhashi, Yukiko Yamada, Machiko Yabana, Yoshiyuki Toya, and Kouichi Tamura.
    • Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan.
    • Intern. Med. 2024 Sep 27.

    AbstractObjective Patients undergoing maintenance dialysis are at a higher risk of morbidity and mortality due to severe coronavirus disease 2019 (COVID-19) than the general population. However, longitudinal data regarding this subpopulation of patients are lacking. We therefore examined the prognosis of patients with COVID-19 undergoing maintenance dialysis between 2020 and 2023. In addition, we explored the factors correlated with COVID-19 severity, focusing on the transition thereof throughout the observational period. Methods The primary outcome was the progression to severe or fatal COVID-19. We evaluated the correlation between the primary outcome and baseline demographic and clinical characteristics of patients. Patients undergoing maintenance dialysis who were hospitalized for mild-to-moderate COVID-19 between February 2020 and April 2023 were enrolled at four institutions in Kanagawa, Japan. Results Of the 173 patients, 7 (4.0%) developed severe COVID-19, and 12 (6.9%) died. The severe/death cohort was significantly older, with a higher percentage of unvaccinated patients than the non-severe cohort (58.2% and 25.0%, respectively; p=0.016). Thymus and activation-regulated chemokine levels on admission were lower in the severe/death cohort than in the non-severe cohort, albeit not to a statistically significant degree (148±84 mg/dL and 342±657 pg/mL, respectively; p=0.082). A multivariate logistic regression analysis revealed that the odds ratio for severe morbidity or death was 0.23 (95% confidence interval: 0.07-0.75) for vaccinated patients. Conclusion In patients undergoing maintenance dialysis, the severity rate of COVID-19 is approximately 10%. Vaccination was correlated with a reduced risk of severe COVID-19.

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