nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2022-2-301-321nid-67Research ArticleCOVID-19 И ПОЧКИCOVID-19 AND KIDNEYSОсобенности организации медицинской помощи методами диализа в амбулаторных условиях при пандемии COVID-19The management of medical care with dialysis methods in outpatients during the COVID-19 pandemicИльинА. П.IlyinA. P.noemail@neicon.ruГуревичК. Я.GurevichK. Ya.noemail@neicon.ruДенисовА. Ю.DenisovA. Yu.Alexey.Denisov@fmc-ag.ruШиловЕ. М.ShilovE. M.noemail@neicon.ruШиловаМ. М.ShilovaM. M.noemail@neicon.ruБрыгинаН. А.BryginaN. A.noemail@neicon.ruКодюшеваО. А.KodyushevaO. A.noemail@neicon.ruOOO Фрезениус Медикал Кеа РоссияРоссияOOO Fresenius Medical Care RussiaRussian FederationПервый Московский Государственный медицинский университет им. И.М. Сеченова, Клиника Нефрологии Внутренних Профессиональных Болезней им. Е.М. ТарееваРоссияFirst Moscow State Medical University IM Sechenov, Clinic of Nephrology of Internal Occupational Diseases named after E.M. TareevaRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202221062024242301321Copyright © Ильин А.П., Гуревич К.Я., Денисов А.Ю., Шилов Е.М., Шилова М.М., Брыгина Н.А., Кодюшева О.А., 20242024Ильин А.П., Гуревич К.Я., Денисов А.Ю., Шилов Е.М., Шилова М.М., Брыгина Н.А., Кодюшева О.А.Ilyin A.P., Gurevich K.Y., Denisov A.Y., Shilov E.M., Shilova M.M., Brygina N.A., Kodyusheva O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/67

Введение. Пандемия COVID-19 изменила систему оказания медицинской помощи пациентам c ХБП 5 стадии. Пациенты, получающие лечение диализом, являются группой особо высокого риска заражения COVID-19, тяжелого течения инфекции и неблагоприятных исходов заболевания. Материалы и методы. В 2020 г. в 86 клиниках FME РФ получали лечение методами диализа 11 331 пациент (54,1% - мужчины), сахарный диабет был у 21,8%, 10 717 пациентов лечились методами ГД и ГДФ, 614 методами ПД, медицинскую помощь им оказывали 2854 сотрудника. Данные собирались при помощи БД EuCliD. Статистическая обработка выполнялась он-лайн калькуляторами сайтов https://molbiol.kirov.ru и https://medstatistic.ru. Результаты. COVID-19 чаще выявлялся у мужчин, пациентов в возрасте от 40 до 79 лет и у пациентов с сахарным диабетом. Процент заболевших пациентов <50 лет (31,2% от всех пролеченных), составил 22,8% от всех инфицированных, а в группе>50 лет (68,8% от всех пролеченных) процент заболевших составил 77,2%. Между частотой поражения инфекцией COVID-19 групп (≥50 и <60 лет), (≥60 и <70 лет), (≥70 и <80 лет), (≥80 лет) достоверных различий установлено не было. COVID-19 позитивные пациенты (на ГД и ПД), умершие в 2020 году - 324 человека, составили 2,9% от всех пролеченных за год и 31,6% от всех инфицированных диализных пациентов. В клиниках FMЕ РФ лечились ГД и ПД 18,6% и 18,4% от всех больных РФ, соответственно, но доля летальности от COVID-19 в клиниках FME РФ составила 10,5% на ГД и 11,0% на ПД соответственно. В диализных центрах FME РФ пациентов с COVID-19 на ГД оказалось в 2,2 раза меньше, чем в диализных центрах РФ в целом (p<0,001), а на ПД - в 1,98 раза меньше, чем в РФ (p<0,001). У пациентов РФ с COVID-19 на ПД и ГД было установлено, что фатальные потери были достоверно ниже при лечении методами ПД в сравнении с ГД (p<0,001). Достоверного влияния на исходы у пациентов с COVID-19 в зависимости от метода лечения в медицинских организациях FMЕ РФ выявлено не было (p=0,349). Заключение. Пациенты, получающие лечение диализом, подвержены большей опасности заражения COVID-19 и фатального исхода болезни. Административно-организационная и лечебная работа FMЕ РФ привела к положительным результатам как в профилактике инфицирования, так и в исходах лечения.

Introduction: The COVID-19 pandemic has changed the health care system for patients with CKD5. Dialysis patients are at particularly high risk of COVID-19, severe infection, and poor outcomes. Materials and methods: In 2020, in 86 FME RF clinics, 11 331 patients (54.1% - men) received dialysis treatment, 21.8% had DM, 10 717 patients were treated with HD and HDF methods, 614 patients were on PD, and 2854 employees provided medical care. The data were collected using the EuCliD database and statistically processed online at sites https://molbiol.kirov.ru and https://medstatistic.ru. Results: COVID-19 is more often detected in men, patients 40 to 79 y.o., in patients with DM. The rate of sick patients <50 y.o. (31.2% of all treated) was 22.8% of all infected and in the group>50 y.o. (68.8% of all treated), the rate of patients was 77.2%. There were no significant differences between the incidence of COVID-19 infection in groups ≥50 and <60 y.o., ≥60 and <70 y.o., ≥70 and <80 y.o., ≥80 y.o. COVID-19 positive patients (on HD and PD) who died in 2020 - 324 people, were 2.9% of all treated in 2020 and 31.6% of all infected dialysis patients. In FME RF clinics 18.6% and 18.4% of all patients in the RF were treated by HD and PD respectively, but the proportion of mortality from COVID-19 in FME RF clinics was 10.5% at HD and 11.0% at PD respectively. In dialysis centers, FME RF patients with COVID-19 on HD were 2.2 times less than in the dialysis population of RF as a whole (p<0.001), and on PD - 1.98 times less than in RF (p<0.001). In RF patients with COVID-19 on PD and HD, it was found that the mortality rate was significantly lower in patients on PD vs HD (p<0.001). There was no significant effect on the outcomes in COVID-19 patients depending on the method of treatment in FME RF clinics (p=0.349). Conclusion: Patients on dialysis are at greater risk of COVID-19 and fatal outcomes. The administrative, organizational, and medical work of FME RF led to positive results both in the prevention of infection and in treatment outcomes.

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Москва 2020Рекомендации по организации противоэпидемического режима в медицинских организациях при оказании медицинской помощи населению в период сезонного подъема заболеваемости острыми респираторными инфекциями и гриппом в условиях сохранения рисков инфицирования новой коронавирусной инфекцией (COVID-19) МР 3.1 02.09.20. Москва 2020

The authors declare that there are no conflicts of interest present.