COVID-19 Ntawm cov neeg mob hauv tsev kho mob nrog rau mob raum: Kev Paub Ntawm Lub Tsev Kho Mob Midwestern Academic Medical Center Ⅱ
Aug 09, 2023
Kev sib tham
Hauv ib-chaw pab pawg neeg no ntawm COVID-19 hauv cov neeg mobkab mob raumpw hauv tsev kho mob thawj zaug ntawm peb lub zos kis thoob qhov txhia chaw, peb tau pom tus nqi siabua pa tsis ua haujlwm, RT xav tau, thiab kev tuag, tshwj xeeb tshaj yog nyob rau hauv cov neeg uas muaj AKI. Cov hnub nyoog laus thiab pab pawg neeg mob tau muaj kev sib raug zoo ntawm kev tuag, uas yog qis duaCKD-5Dthiab KTx piv rau AKI cov neeg mob hauv peb pawg. Kev rog rog tau cuam tshuam nrog tsib npaug ntawm kev tuag raws li BMI li qub hauv COVID-19 cov neeg mob AKI (OR, 5.15; 95% CI 1.38–19.22) tab sis tsis nyob hauv CKD-5D thiab KTx cov neeg mob.
NYEEM NTXIV NTAWM NO kom tau txais ib qho tshuaj ntsuab tshiab CISTANCHE rau CKD kev kho mob
Cov kev tshawb fawb yav dhau los tau tshaj tawm cov neeg tuag coob ntawm COVID-19 cov neeg mob nrog AKI.12–14 Kev tshawb fawb ntawm KTx cov neeg tau txais kev kho mob hauv tsev kho mob nrog COVID-19 kuj tau kwv yees kev tuag siab nyob rau thaj tsam ntawm 20–40%, piv nrog 10– 15% kev tuag ntawm cov neeg mob hauv tsev kho mob dav dav COVID-19.9 Lwm cov kev tshawb fawb pom muaj cov neeg tuag coob dua hauv tsev kho mob COVID-19 cov neeg mob CKD thiab nyob rau hauv cov mob hemodialysis thaum piv nrog cov neeg mob KTx.15,16 Hauv cov kev tshawb fawb no, cov Qhov tshwm sim tsis zoo tshaj plaws tau pom nyob rau hauv cov neeg mob CKD nthuav tawm nrog AKI ntawm CKD.15,16 Cov neeg tuag tsawg dua hauv peb cov neeg tau txais kev kho mob hauv tsev kho mob KTx piv rau cov ntawv tshaj tawm yav dhau los yuav yog nrog cov qauv nkag thiab/lossis lwm yam xws li hnub nyoog, qhov chaw pub dawb, induction thiab kev tiv thaiv kev tiv thaiv. , as Well as variation muab tus qauv loj. Qhov kev pheej hmoo tuag ntau ntxiv los ntawm COVID-19 hauv KTx yav dhau los cov pab pawg tau nrog cov hnub nyoog laus dua, lwm yam kev kho mob, thiab tau txais cov nyiaj pub dawb rau cov neeg tuag tab sis tsis yog rog.9 Hauv peb pawg, cov hnub nyoog nruab nrab ntawm pawg KTx yog 63.3 xyoo. . Hauv kev soj ntsuam meta-tshaj tawm tsis ntev los no ntawm KTx cov neeg tau txais nrog COVID-19, cov neeg muaj sia nyob thiab cov neeg tsis muaj sia nyob 54.9 piv rau 67.5 xyoo, raws li. Zoo ib yam li cov kev tshawb fawb tam sim no, kev rog rog tsis txawv ntawm cov neeg muaj sia nyob (46.8%) thiab cov neeg tsis muaj sia nyob (49.8%) KTx tau txais. Kev kho tshuaj tiv thaiv kab mob, tshwj xeeb tshaj yog MPA, tau pib qhia tias yuav cuam tshuam rau COVID-19 qhov tshwm sim.17 Tam sim no, txoj hauv kev dav dav ntawm ntau lub chaw hloov pauv yog kom txo qis tag nrho cov tshuaj tiv thaiv kab mob nrog ib qho tshwj xeeb ntawm kev txo qis lossis nres cov tshuaj antimetabolite xws li MPA los yog azathioprine. Txoj hauv kev no yog ua raws li cov kws tshaj lij kev xav tau tsim los ua ke nrog ntau lub zej zog kev tshaj lij.17 Ntawm 5 KTx cov neeg mob uas tuag hauv peb pawg, 2 (40%) tau noj MPA ntawm kev nkag, thaum 54% ntawm cov neeg muaj sia nyob tau noj peb zaug kev tiv thaiv kab mob suav nrog MPA. . Qhov muaj feem cuam tshuam ntawm kev tiv thaiv kab mob tiv thaiv kab mob ntawm cov txiaj ntsig xav tau kev tshawb nrhiav ntxiv thiab yuav hloov zuj zus raws li SARS-CoV-2 cov tshuaj tiv thaiv kab mob nrog cov tshuaj tiv thaiv kab mob muaj zog nrog calcineurin inhibitors (nirmatrelvir / ritonavir) dhau los. Cov neeg tuag kuj tseem tuaj yeem cuam tshuam los ntawm kev nkag mus rau kev saib xyuas thiab kab mob hnyav ntawm kev nthuav qhia. Nws yog qhov ua tau tias cov neeg mob hloov pauv tau mus pw hauv tsev kho mob nrog mob me me ntawm peb lub tsev kho mob thaum thawj tus kab mob COVID-19 nce siab, ua rau muaj kev txo qis kev tuag.
Kev rog rogtau raug txheeb xyuas tias yog qhov muaj feem pheej hmoo rau COVID{0}} kev tuag nyob rau hauv dav davpej xeem.14,18Ib yam li ntawd, kev rog rog kuj pom tias muaj kev sib raug zoo ntawm 5-fold nceKev tuag hauv COVID-19 cov neeg mob nrog AKI tau pw hauv tsev kho mob ntawm peb lub chaw. Txawm li cas los xij, qhov noKev koom tes tsis tau pom ntawm CKD-5D thiab KTx pab pawg hauv peb pawg. Kev rog thiabKev tuag muaj kev sib raug zoo nyob rau hauv cov neeg mob ntshav qab zib, nrog rau kev rog rognrog rau cov ciaj sia taus zoo, tshwj xeeb tshaj yog nyob rau hauv cov neeg tau txais hemodialysis.19Tej yam tshwm simntawm kev rog rog tsis txaus ntseeg hauv CKD-5D cov neeg mob tuaj yeem suav nrog cov xwm txheej hemodynamic ruaj khov,Kev hloov pauv hauv kev ncig cytokines, tsawg dua kev noj zaub mov tsis zoo cuam tshuam nrog o, thiab txawvneurohormonal qauv. Thaum rog rog tau cuam tshuam nrog kev tuag qis hauvCKD{{0}}D cov neeg mob nrog COVID-19, qhov txawv yog tsawg dua 1.0. Thaum xav tau kev ua haujlwm ntau ntxivnkag siab txog kev sib cuam tshuam ntawm kev mob, kev rog, thiab kab mob raum hauv COVID-19- cuam tshuamCov txiaj ntsig, hauv peb cov pej xeem peb suav tias kev rog rog yog qhov muaj feem cuam tshuam los txhawb kev sab lajntawm qhov tseem ceeb ntawm COVID-19 cov tswv yim tiv thaiv tshwj xeeb tshaj yog nyob rau hauv pre-dialysis CKDcov pej xeem muaj kev pheej hmoo rau AKI nrog COVID-19.
Txog niaj hnub no, ntau yam kev pheej hmoo tau piav qhia txog qhov tshwm sim tsis zoo suav nrog kev tuag hauv cov neeg mob raum nrog COVID-19 suav nrog hnub nyoog laus, txiv neej poj niam txiv neej, haiv neeg Dub, ntshav qab zib, thiab kab mob plawv.20–23 Peb txoj kev tshawb fawb txheeb xyuas lub luag haujlwm ntawm cov hnub nyoog laus dua yog qhov muaj feem pheej hmoo tuag rau cov neeg mob raum nrog COVID-19, thiab ib yam li cov neeg mob rog, peb ntuas cov lauscov neeg mob raumntawm qhov xav tau kev ceev faj hauv kev tiv thaiv kev tiv thaiv COVID-19. Peb tsis tau soj ntsuam kev sib txawv ntawm haiv neeg hauv cov txiaj ntsig, tab sis tus qauv no yuav cuam tshuam los ntawm cov haiv neeg Dub feem ntau ntawm peb pawg neeg. Peb cov qauv me me uas txwv tsis pub muaj zog rau kev tshawb nrhiav lwm yam kev pheej hmoo kev sib raug zoo, tab sis kuj tseem hais txog qhov tseem ceeb ntawm kev sib raug zoo nrog lub hnub nyoog thiab kev rog hauv pawg AKI. Lwm qhov kev txwv ntawm txoj kev tshawb no yog qhov AKI theem tsis tau teev tseg.
Kev kho mob rau COVID-19 tau hloov zuj zus los ntawm kev sib kis. Hauv thawj qhov kev nce siab, kev siv thaum ntxov ntawm hydroxychloroquine thiab azithromycin tau hloov los ntawm dexamethasone thiab remdesivir ua pov thawj hloov zuj zus. Txawm hais tias muaj kev txhawj xeeb rau tsub zuj zuj ntawm cov cab kuj sulfobutyl- -cyclodextrin ntawm redeliver nyob rau hauv cov neeg mob uas tsis tshua muaj kwv yees glomerular filtration rate (eGFR), cov kev tshawb fawb tshwm sim qhia tau hais tias muaj kev ruaj ntseg ntawm redeliver siv nyob rau hauvlub raum mpaired COVID-19cov neeg mob nrog eGFR< 30 ml/min and the potential benefit outweighing the theoretical risk of liver or kidney toxicity.24,25 However, remdesivir use was lower in our CKD-5D and KTx ients. Although further clinical trials are needed to improve knowledge of the safety and efficacy of remdesivir, retrospective studies can also inform and help providers' clinical decision-making on remdesivir use in patients with kab mob raum.
Muab qhov chaw hloov pauv sai sai ntawm COVID-19 qhov tshwm sim, kev txhaj tshuaj tiv thaiv, thiab kev kho mob, nkag siab txog tus tsav tsheb tseem ceeb ntawm COVID-19 cov txiaj ntsig hauvtus neeg mob lub raumpawg sib tw yog qhov nyuaj. Kev txhaj tshuaj tiv thaiv tau muaj rau cov neeg mob uas muaj kev pheej hmoo siab thaum xyoo 2020, thiab muaj ntau ntxiv nrog cov khoom siv ntxiv. Qhov tseem ceeb, cov ntaub ntawv tawm tshiab tau pom tias txo qis cov tshuaj tiv thaiv kab mob rau cov tshuaj tiv thaiv ntawm cov neeg mob tiv thaiv kab mob xws li cov neeg tau txais kev hloov pauv, lees paub cov tshuaj tiv thaiv kab mob. Tsis tas li ntawd, txawm tias muaj kev pheej hmoo siab ntawm COVID-19, cov tshuaj tiv thaiv tsis txaus ntseeg tseem nyob hauv qee pawg.26Thaum pom qhov cuam tshuam ntawm kev hloov pauv sai sai yog qhov nyuaj, kev taug qab cov pab pawg tuaj yeem muaj txiaj ntsig zoo rau kev nkag siab txog kev siv cov peev txheej, sib piv cov txiaj ntsig ntawm cov chaw thiab thaj chaw, thiab nrhiav cov xwm txheej uas yuav kwv yees cov txiaj ntsig zoo dua lossis phem dua.
Hauv cov ntsiab lus, peb tau pom tus nqi siab ntawm COVID-19- cuam tshuam txog kev ua pa tsis ua haujlwm, RRT xav tau thiab kev tuag hauv cov neeg mobkab mob raumtau mus pw hauv tsev kho mob thawj zaug ntawm peb lub zos kis thoob qhov txhia chaw, tshwj xeeb tshaj yog cov uas muaj AKI. Kev tuag yog qhov siab tshaj plaws hauv cov neeg laus thiab cov neeg mob rog rog nrog AKI. Thaum tag nrhocov neeg mob raumyuav tsum tau sab laj txog kev ua raws li COVID-19 kev tiv thaiv kev ntsuas suav nrogtxhaj tshuaj tiv thaiv, nkag siab txog cov xwm txheej txaus ntshai, thiab kev tuag cuam tshuam nrog COVID-19 hauv pawg pab pawg no txhawb nqa tshwj xeeb rau cov pab pawg tsis muaj zog. Hauv peb qhov kev paub hauv zos, sib qhia cov ntaub ntawv no hauv kev tawm tswv yim niaj hnub tau txhawb qee cov neeg mob uas tsis kam txhaj tshuaj tiv thaiv kom mus txhaj tshuaj tiv thaiv. Kev txiav txim siab hauv kev nce qib tshiab suav nrog cov txiaj ntsig ntawm kev txhaj tshuaj ntxiv, kev siv cov tshuaj tiv thaiv kab mob monoclonal rau cov kab mob ntxov lossis kev tiv thaiv kab mob ua ntej, kev kho qhov ncauj ntawm qhov ncauj, thiab rau cov neeg hloov pauv, siv cov khoom nruab nrog cev los ntawm cov neeg pub dawb nrog keeb kwm ntawm COVID-19 rau kev hloov pauv .27Kev kawm txuas ntxiv thiab kev saib xyuas yog xav tau thaum peb nrhiav kev txhim kho kev saib xyuas cov neeg mob tsis zoo no los ntawm kev muaj tus kabmob kis mus ntxiv.
TXOJ CAI
Peb ua tsaug rau cov neeg ua haujlwm pem hauv ntej thiab cov kws kho mob rau lawv txoj kev mob siab rau kev saib xyuas raum rau tus neeg mob thaum lub sijhawm COVID-19 muaj thoob qhov txhia chaw, suav nrog cov kws kho mob nephrologist, intensivists, kws saib xyuas neeg mob, kws kho mob thiab cov kws kho mob hauv zej zog. Peb ua tsaug rau biostatistician Huiling Xiao, MS, thiab Kennan Maher rau kev pab npaj sau ntawv. Ib qho kev piav qhia txog cov haujlwm no tau nthuav tawm ntawm National Kidney Foundation (NKF) Virtual Spring Clinical Meeting, Peb Hlis 2021, thiab ntawm St. Louis NKF Renal Roundtable, Kaum Ob Hlis 2, 2021https://www.youtube.com/watch?v=GWLPcFezxcg&t=2s.
NYIAJKLL tau txais kev txhawb nqa los ntawm Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation thiab tau txais kev tshawb fawb txog kev mob raum thiab hloov pauv los ntawm National Institutes of Health (R01DK120518).
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