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Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort

Guillaume Lano 1 Antoine Braconnier 2 Stanislas Bataille 1 Guilhem Cavaille 3 Julie Moussi-Frances 3 Bertrand Gondouin 4, 5 Pascal Bindi 6 Magued Nakhla 7 Janette Mansour 8 Pascale Halin 9 Bénédicte Levy 10 Eric Canivet 11 Khaled Gaha 2 Isabelle Kazes 2 Natacha Noel 2 Alain Wynckel 2 Alexandre Debrumetz 2 Noemie Jourde-Chiche 1 Valerie Moal 4 Romain Vial 4 Violaine Scarfoglière 4 Mickael Bobot 1 Marion Gully 4 Tristan Legris 4 Marion Pelletier 4 Marion Sallee 1 Stephane Burtey 1, 12 Philippe Brunet 1, 12 Thomas Robert 4 Philippe Rieu 2
1 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
2 CHU Reims - Centre Hospitalier Universitaire de Reims
3 Service d'hépatologie et de gastroentérologie [Hôpital Saint-Joseph - Marseille]
4 APHM - Assistance Publique - Hôpitaux de Marseille
5 Association Dialyse Provence Corse
6 Centre Hospitalier de Verdun Saint-Mihiel
7 CH Laon - Centre Hospitalier de Laon
8 hopital
9 Centre Hospitalier de Charleville-Mezières
10 CH de Troyes
11 ARPDD - Association Regionale Promotion Dialyse Domicile
12 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
Abstract : Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD). Methods We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality. Results Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses. Conclusions COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.
Keywords : angiotensin II receptor blockers COVID-19 dialysis hydroxychloroquine lymphocytes CORONAVIRUS DISEASE 2019 HEMODIALYSIS-PATIENTS BLOCKADE OUTBREAK OUTCOMES
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https://hal-amu.archives-ouvertes.fr/hal-03208384
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Submitted on : Monday, April 26, 2021 - 2:57:41 PM
Last modification on : Wednesday, November 3, 2021 - 4:16:47 AM

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Guillaume Lano, Antoine Braconnier, Stanislas Bataille, Guilhem Cavaille, Julie Moussi-Frances, et al.. Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort. Clinical Kidney Journal, Oxford University Press, 2020, 13 (5), pp.878-888. ⟨10.1093/ckj/sfaa199⟩. ⟨hal-03208384⟩

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