Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients: A Single-Center Experience
Incidence and Immunologic Analysis of Coronavirus Disease (COVID-19) in Hemodialysis Patients: A Single-Center Experience
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DOI：
10.6002/ect.2020.0194
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发表时间：
2020-06-01
影响因子：
0.9
通讯作者：
Haberal, Mehmet
中科院分区：
文献类型：
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作者：
Arslan, Hande;Musabak, Ugur;Haberal, Mehmet
目的：COVID-19是现代世界的巨大威胁，也是免疫功能低下患者（包括慢性肾衰竭患者）的重大威胁。我们评估了血液透析患者中COVID-19的发病率，并调查了最可能的免疫机制。材料和方法：Baskent大学在土耳其有21个透析中心，有2420名血液透析患者和30名腹膜透析患者。其中，我们回顾性评估了602例（257例女性/345例男性）慢性肾功能衰竭患者接受血液透析作为肾脏替代治疗; 7例患者（1.1%）感染了SARS-CoV-2。我们回顾性收集了患者的人口统计学特征、临床资料和影响疾病临床病程的免疫学因素。我们将患者分组，并包括2个对照组（肾功能正常的个体）：I组包括肾功能正常的COVID-19阳性患者，II组包括COVID-19阳性血液透析患者，III组包括COVID-19阴性血液透析患者，IV组包括肾功能正常的COVID-19阴性患者。分析各组患者外周血淋巴细胞亚群和人类白细胞抗原分型，仅分析COVID-19阳性患者和健康对照者的杀伤细胞免疫球蛋白样受体基因。结果：7例COVID-19阳性血液透析患者中无死亡病例。第I组患者的年龄显著大于第II组和第III组患者（分别为P = 0.039，P = 0.030），但与第IV组患者无显著差异（P = 0.060）。健康对照组中自然杀伤细胞的绝对计数高于其他组（但不显著）。与COVID-19阴性组相比，COVID-19阳性组的活化T细胞均显著增加。两组在C和DQ基因座上的等位基因分布存在显著差异。结论：尽管免疫功能低下的患者患COVID-19的风险更大，但我们发现血液透析患者的COVID-19发病率较低，这应在体外和分子研究中进一步研究。
Objectives: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19.Materials and Methods: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups ( individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin-like receptor genes analyzed only in COVID-19-positive patients and healthy controls.Results: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III ( P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higher than in other groups (but not significantly). Activated T cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes.Conclusions: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.