Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients.

BACKGROUND: The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown. HYPOTHESIS: We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD. METHODS: A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan-Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. RESULTS: The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates. CONCLUSIONS: The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.

Response of fine particulate matter and ozone concentrations to meteorology and anthropogenic precursors over the "2+26" cities of northern China.

Analyzing the influencing factors of fine particulate matter and ozone formation and identifying the coupling relationship between the two are the basis for implementing the synergistic pollutants control. However, the current research on the synergistic relationship between the two still needs to be further explored. Using the Geodetector model, we analyzed the effects of meteorology and emissions on fine particulate matter and ozone concentrations over the "2 + 26" cities at multiple timescales, and also explored the coupling relationship between the two pollutants. Fine particulate matter concentrations showed overall decreasing trends on inter-season and inter-annual scale from 2015 to 2021, whereas ozone concentrations showed overall increasing trends. While ozone concentrations displayed an inverted U-shaped distribution from month to month, fine particulate matter concentrations displayed a U-shaped fluctuation. On inter-annual scale, climatic factors, with planet boundary layer height as the main determinant, have higher effects for both pollutants than human precursors. In summer and autumn, sunshine duration had the most influence on fine particulate matter, while planet boundary layer height was the greatest factor in winter. Fine particulate matter is the leading impacting factor on ozone concentrations in summer, and there were positive associations between them on both annual and seasonal scale. The impact of nitrogen oxides and volatile organic compounds for both pollutants concentrations varied significantly between seasons. The two pollutants concentration were enhanced by the interactions between the various components. On inter-annual scale, interactions between the planet boundary layer height and other factors dominated the concentrations of the two pollutants, whereas in summer, interactions between fine particulate matter and other factors dominated the concentrations of ozone. The study has implications for the treatment of atmospheric pollution in China and other nations and can serve as an important reference for the creation of integrated atmospheric pollution regulation policies over the "2 + 26" cities.

Evolution of surface ozone pollution pattern in eastern China and its relationship with different intensity heatwaves.

With climate warming, eastern China has experienced a significant increase in temperature accompanied by intensified ozone pollution. We aimed to investigate the spatiotemporal patterns and relationships between ozone levels and temperature in eastern China using observation-based ozone data from 418 air quality monitoring stations and temperature data from ERA5. The summer maximum temperature and annual ozone concentration in eastern China increased significantly between 2015 and 2022, with increases rate of 10% and 2.84 µg/m3 yr-1, respectively. The baseline ozone concentration was increasing over time. The average difference in MDA8 O3 concentration in spring, summer, and autumn decreased, with more ozone pollution spreading into spring and autumn, indicating a trend of prolonging the ozone season. During the June-July-August (JJA) period of 2015-2022, heatwaves increased significantly in eastern China. The frequency of heatwave events >10 days played a vital role in exacerbating ozone pollution. During the JJA period, the increase rate in MDA8 O3 concentration was 9.31 µg/m3 yr-1 during heatwave periods, significantly higher than that during non-heatwave periods (4.01 µg/m3 yr-1). The correlation between MDA8 O3 concentration and temperature was as high as 0.99, indicating that temperature was vital in ozone formation during the JJA period in eastern China. This study suggests that more stringent actions are needed to control ozone-precursor compounds during frequent summertime heatwaves in eastern China.

Assessment of the supply/demand balance of medical resources in Beijing from the perspective of hierarchical diagnosis and treatment.

Considering the United Nations' Sustainable Development Goals (SDGs) and the need for a balanced spatial distribution of urban medical resources capable of perspective of hierarchical diagnosis and treatment, i.e. providing continuous and accessible medical services during potential public health emergencies, we assessed accessibility and service capacity of the three hospital levels in Beijing. Using geographical information systems (GIS) and the two-step floating catchment area method with the street as research unit, we found that there is an over-supply of medical resources in the centre of the city with weaker support in the peripheral areas as manifested by less supply in relation to popular demand of medical services. The spatial distribution of hospitals at all levels and their resources was found to be uneven: 82.4% of the residents can reach a tertiary hospital (a hospital offering advanced specialized medical and health services to multiple regions) within a 15-minute drive; 50.6% can reach a secondary hospital (a hospital offering comprehensive medical and health services to various communities) within a 10-minute drive; and 77.6% can reach a primary hospital (a hospital directly delivering prevention, medical treatment, healthcare, and rehabilitation services to the community of a certain population) within a 15- minute walk. It was noted that the supply/demand balance of medical resources in the tertiary hospitals decreases from the centre to the periphery, while the secondary hospitals show a dual-centre pattern and the primary hospitals a more uneven distribution, with oversupply in the East and the opposite in the Centre. The results of the study provide supplementary decision support for improving the hierarchical diagnosis and treatment system and accelerate the overall deployment of medical resources.

The number of valvular insufficiency is a strong predictor of cardiovascular and all-cause mortality in hemodialysis patients.

OBJECTIVES: To investigate the relationship between the number of valvular insufficiency (VI) and emergency hospitalization or mortality in maintenance hemodialysis (HD) patients. METHODS: The maintenance HD patients with cardiac ultrasonography were included. According to the number of VI ≥ 2 or not, the patients were divided into two groups. The difference of emergency hospitalized for acute heart failure, arrhythmia, acute coronary syndrome (ACS) or stroke, cardiovascular mortality, and all-cause mortality between the two groups were compared. RESULTS: Among 217 maintenance HD patients, 81.57% had VI. 121 (55.76%) patients had two or more VI, and 96 (44.24%) with one VI or not. The study subjects were followed up for a median of 47 (3-107) months. At the end of the follow up, 95 patients died (43.78%), of whom 47 (21.66%) patients died because of cardiovascular disease. Age (HR 1.033, 95% CI 1.007-1.061, P = 0.013), number of VI ≥ 2 (HR 2.035, 95% CI 1.083-3.821, P = 0.027) and albumin (HR 0.935, 95% CI 0.881-0.992, P = 0.027) were independent risk factors for cardiovascular mortality. The three parameters were also independent risk factors for all-cause mortality. The patients with number of VI ≥ 2 were more likely to be emergency hospitalized for acute heart failure (56 [46.28%] vs 11 [11.46%], P = 0.001). On the contrary, the number of VI was not associated with emergency hospitalized for arrhythmia, ACS or stroke. Survival analysis results showed that probability of survival was statistically different in the two groups (P < 0.05), no matter based on cardiovascular mortality or all-cause mortality. Based on age, number of VI ≥ 2 and albumin, nomogram models for 5-year cardiovascular and all-cause mortality were built. CONCLUSIONS: In maintenance HD patients, the prevalence of VI is prominently high. The number of VI ≥ 2 is associated with emergency hospitalized for acute heart failure, cardiovascular and all-cause mortality. Combining age, number of VI ≥ 2, and albumin can predict cardiovascular and all-cause mortality.

Impact of Land Use Change on the Habitat Quality Evolution in Three Gorges Reservoir Area, China.

Habitat quality (HQ) is an important indicator to characterize the level of biodiversity and ecosystem services, and can reflect the quality of the human living environment. Changes in land use can disturb regional HQ. Current research mostly focuses on assessing the good or bad quality of regional habitats, and less on the spatial response relationship between land use change and HQ, and even fewer studies on finely distinguishing the impact of land use types on HQ. Therefore, taking Three Gorges Reservoir Area (TGRA) of China as the study area, this paper first analyzes the land use change of study area by using the land use transfer matrix, land use rate model and landscape pattern index, and then combines the InVEST model with the multi-scale geographically weighted regression (MGWR) model to build a refined assessment framework to quantitatively assess the spatial and temporal evolution patterns of HQ, and then analyse in detail the spatial response relationship of each land use type change on the impact of HQ. The results showed that from 2000 to 2020, the land use in the TGRA shows a changing state of "urban expansion, cultivated land shrinkage, forest land growth, and grassland degradation". With the change in land use, the habitat quality index (HQI) in the study area showed an " increase first and then decline" change characteristics, and the HQ degradation was more obvious in the areas with intense human activities. The impact of land use change over the past 20 years on HQ in the TGRA has significant spatial and temporal heterogeneity, with changes in paddy and dryland having mainly negative impacts on HQ, and changes in sparse land, shrubland, and medium-cover grassland having mainly positive impacts on HQ. This paper mainly provides a research framework for refined assessment, and the results can provide scientific support for land planning and ecological protection in the TGRA, and the research methods and ideas can provide references for similar research.

Multi-Scale Effects of Meteorological Conditions and Anthropogenic Emissions on PM2.5 Concentrations over Major Cities of the Yellow River Basin.

The mechanism behind PM2.5 pollution is complex, and its performance at multi-scales is still unclear. Based on PM2.5 monitoring data collected from 2015 to 2021, we used the GeoDetector model to assess the multi-scale effects of meteorological conditions and anthropogenic emissions, as well as their interactions with PM2.5 concentrations in major cities in the Yellow River Basin (YRB). Our study confirms that PM2.5 concentrations in the YRB from 2015 to 2021 show an inter-annual and inter-season decreasing trend and that PM2.5 concentrations varied more significantly in winter. The inter-month variation of PM2.5 concentrations shows a sinusoidal pattern from 2015 to 2021, with the highest concentrations in January and December and the lowest from June to August. The PM2.5 concentrations for major cities in the middle and downstream regions of the YRB are higher than in the upper areas, with high spatial distribution in the east and low spatial distribution in the west. Anthropogenic emissions and meteorological conditions have similar inter-annual effects, while air pressure and temperature are the two main drivers across the whole basin. At the sub-basin scale, meteorological conditions have stronger inter-annual effects on PM2.5 concentrations, of which temperature is the dominant impact factor. Wind speed has a significant effect on PM2.5 concentrations across the four seasons in the downstream region and has the strongest effect in winter. Primary PM2.5 and ammonia are the two main emission factors. Interactions between the factors significantly enhanced the PM2.5 concentrations. The interaction between ammonia and other emissions plays a dominant role at the whole and sub-basin scales in summer, while the interaction between meteorological factors plays a dominant role at the whole-basin scale in winter. Our study not only provides cases and references for the development of PM2.5 pollution prevention and control policies in YRB but can also shed light on similar regions in China as well as in other regions of the world.

Effects of anthropogenic precursor emissions and meteorological conditions on PM2.5 concentrations over the "2+26" cities of northern China.

Elucidating the characteristics and influencing mechanisms of PM2.5 concentrations is the premise and key to the precise prevention and control of air pollution. However, the temporal and spatial heterogeneity of PM2.5 concentrations and its driving mechanism are complex and need to be further analyzed. We analyzed the temporal and spatial variations of PM2.5 concentrations in the "2 + 26" cities from 2015 to 2021, and quantified the influence of meteorological factors and anthropogenic emissions and their interactions on PM2.5 concentrations based on geographic detector model. We find the inter-annual and inter-season PM2.5 concentrations show downward trend from 2015 to 2021, and the inter-month PM2.5 concentrations present a U-shaped distribution. The PM2.5 concentrations in the "2 + 26" cities manifest a spatial distribution pattern of high in the south and low in the north, and high in the middle and low in the surroundings. Meteorological conditions have stronger effects on PM2.5 concentrations than anthropogenic emissions, and planetary boundary layer height and temperature are the two main driving factors at the annual scale. On the seasonal scale, sunshine duration is the dominant factor of PM2.5 concentrations in summer and autumn, and planetary boundary layer height is the dominant factor of PM2.5 concentrations in winter. The effect of anthropogenic emissions on PM2.5 concentration is higher in winter and spring than in summer and autumn, and ammonia and ozone have stronger effects on PM2.5 concentrations than other anthropogenic emissions. Interactions between the factors significantly enhance the PM2.5 concentrations. The interactions between planetary boundary layer height and other impacting factors play dominant roles on PM2.5 concentrations at annual scale and in winter. Our results not only provide crucial information for further developing air quality policies of the "2 + 26" cities, but also bear out several important implications for clean air policies in China and other regions of the world.

Evaluating soil-water conserving performance of land management strategies for spoil tips on the Chinese Loess Plateau.

Surface runoff decrease (SRD) and sediment concentration change (SCC) are accountable for sediment reduction by anti-erosion strategies. Using a design of horizontal stages, contour trenches, fish-scale pits, as well as their combinations, this study evaluated the two components for sediment reduction after the implementation of various land management strategies on steep spoil tips. The study highlighted the interactions between SRD and SCC in reducing sediment, and characterized the temporal variations of sediment-reducing capacity by SRD and SCC. Results showed that slope erosion was well controlled with control ratios of sediment yield ranging from 0.4 to 0.59, 0.2 to 0.22, for horizontal stage- and contour trench-based strategies, respectively. Sediment-reducing benefit by SRD accounted for 52%-77% of the total sediment reduction and highly determined the performance of SCC. Quadratic relationships between sediment-reducing capacity by SCC and that by SRD were observed. The function of SCC only operated when the sediment-reducing capacity by SRD reached a certain threshold. These thresholds varied greatly in the range of 0.75 kg m-3-0.91 kg m-3 and 0.61 kg m-3-0.66 kg m-3 for horizontal stage- and contour trench-based strategies, respectively. The upper limits for sediment-reducing capacity by SCC varied in the range of 0.32 kg m-3-0.44 kg m-3 and 0.63 kg m-3-0.76 kg m-3 for horizontal stage- and contour trench-based strategies, respectively. An efficiency coefficient of 55% and an M-N ratio of 1:1 indicated that sediment-reducing benefits by SRD and SCC were effectively exerted by combining contour trenches and fish-scale pits. The findings emphasized that the application of land management strategies must be considered based on particular goals to restore spoil tips. In practice, if targeted to enhancing sediment-reducing efficiency, contour trenches and fish-scale pits should be primarily considered. However, if the aim is to decrease water consumed for sediment control, then horizontal stages should be principally considered.

Total cholesterol to high-density lipoprotein cholesterol ratio is independently associated with CKD progression.

PURPOSE: Although dyslipidemia can cause kidney damage, whether it independently contributes to the progression of chronic kidney disease (CKD) remains controversial. The research aims to evaluate the predictive value of serum lipids and their ratios in the progression of CKD. METHODS: The retrospective, case-control study included 380 adult subjects with CKD stage 3-4 (G3-4) at baseline. The end point of follow-up was the progression of CKD, defined as a composite of renal function rapid decline [an annual estimated glomerular filtration rate (eGFR) decline > 5 mL/min/1.73 m2] or the new-onset end-stage renal disease (ESRD) [eGFR < 15 mL/min/1.73 m2]. Logistic regression analysis was performed to examine the association between CKD progression and lipid parameters. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of lipid parameters in the progression of CKD. RESULTS: Over a median follow-up of 3.0 years, 96 participants (25.3%) developed CKD progression. In multivariable logistic regression analysis, logarithm-transformed urinary albumin-to-creatinine ratio (log ACR) [odds ratio (OR) 1.834;95% confidence interval (CI) 1.253-2.685; P = 0.002] and total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C) [OR 1.345; 95% CI 1.079-1.677; P = 0.008] were independently associated with CKD progression. The ROC curve showed the combined predictor of ACR and TC/HDL-C ratio was acceptable for CKD progression diagnosis (area under the ROC curve [AUC] = 0.716, sensitivity 50.0%, specificity 84.2%), and the cut-off value was - 0.98. CONCLUSIONS: The combination of TC/HDL-C ratio and ACR had predictive value in the progression of CKD, and may help identify the high-risk population with CKD.

Risk factors for the mortality of hemodialysis patients with COVID-19: A multicenter study from the overall hemodialysis population in Wuhan.

INTRODUCTION: Maintenance hemodialysis (MHD) patients are highly threatened in the novel coronavirus disease 2019 (COVID-19) pandemic, but evidence of risk factors for mortality in this population is still lacking. METHODS: We followed outcomes of the overall MHD population of Wuhan, including 7154 MHD patients from 65 hemodialysis centers, from January 1 to May 4, 2020. Among them, 130 were diagnosed with COVID-19. The demographic and clinical data of them were collected and compared between survivors and nonsurvivors. RESULTS: Compared to the corresponding period of last year, the all-cause mortality rate of the Wuhan MHD population significantly rose in February, and dropped down in March 2020. Of the 130 COVID-19 cases, 51 (39.2%) were deceased. Advanced age, decreased oxygen saturation, low diastolic blood pressure (DBP) on admission, and complications including acute cardiac injury (HR 5.03 [95% CI 2.21-11.14], p < 0.001), cerebrovascular event (HR 2.80 [95% CI 1.14-6.86], p = 0.025) and acute respiratory distress syndrome (HR 3.50 [95% CI 1.63-7.51], p = 0.001) were identified as independent risk factors for the death of COVID-19. The median virus shedding period of survivors was 25 days, longer than the general population. CONCLUSIONS: Maintenance hemodialysis patients are a highly vulnerable population at increased risk of mortality and prolonged virus shedding period in the ongoing COVID-19 pandemic. Advanced age, decreased oxygen saturation, low DBP on admission, and complications like acute cardiac injury are parameters independently associated with poor prognosis.

Correlation between home systolic blood pressure variability and cognitive impairment in maintenance hemodialysis patients.

INTRODUCTION: To investigate the correlation between home blood pressure variability and cognitive function in maintenance hemodialysis (MHD) patients. METHODS: Patients who received MHD were included. Their home blood pressure on nondialysis days within 1 week was collected. All patients were assessed with the Montreal Cognitive Assessment scale, according to which the patients were divided into cognitive impairment (CI) group and non-CI group, and the differences between two groups were compared. RESULTS: A total of 224 patients were included in the study, of which 168 had CI (75%). Compared with non-CI group, patients in CI group had larger variability of systolic blood pressure (SBPV) (8.4 [6.7, 10.6]% vs. 6.9 [4.9, 8.8]%, P < 0.001). The smooth fitting curve (OR = 1.2, 95% CI [1.1-1.4], P < 0.001) and trend test (P for trend = 0.004) showed that the risk of CI raised with the increase of SBPV. The patients were further divided into tertiles according to the SBPV. We also found a gradual increase in the proportion of incident CI in the three tertiles. Multiple logistic regression analysis showed that age, shorter years of education, less frequency of hemodialysis, and greater SBPV were the dependent risk of CI. CONCLUSION: In conclusion, greater SBPV indicates higher risk of cognitive impairment in MHD patients.

Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study.

BACKGROUND: Since the first diagnosed case of infection with the novel coronavirus (SARS-CoV-2), there has been a rapid spread of the disease with an increasing number of cases confirmed every day, as well as a rising death toll. An association has been reported between acute kidney injury (AKI) and mortality in patients infected with SARS-CoV-2. Therefore, our study was conducted to explore possible risk factors of AKI as well as whether AKI was a risk factor for worse outcome, especially mortality among patients with coronavirus disease (COVID-19). METHODS: We included all hospital admissions with confirmed or clinically diagnosed COVID-19 from January 29 to February 25, 2020. We collected demographic and epidemiological information, past medical history, symptoms, laboratory tests, treatments, and outcome data from electronic medical records. A total of 492 patients with diagnosed or clinically diagnosed COVID-19 were included in this study. RESULTS: The prevalence rate of AKI was 7.32%. Among the factors associated with AKI, males versus females (aOR 2.73), chronic kidney disease (aOR 42.2), hypertension (aOR 2.82), increased leucocytes (aOR 6.08), and diuretic use (aOR 7.89) were identified as independent risk factors for AKI among patients infected by SARS-CoV-2. There was a significant difference in hospital fees and death in patients with and without AKI (p < 0.05). The mortality rate in patients with AKI was 63.9%. CONCLUSIONS: AKI was widespread among patients with COVID-19. The risk factors of AKI in COVID-19 patients included sex, chronic kidney disease, hypertension, infection, and diuretic use. AKI may be associated with a worse outcome, especially mortality in COVID-19 patients.

Correlation between laboratory parameters on admission and outcome of COVID-19 in maintenance hemodialysis patients.

PURPOSE: This present study aims to investigate the relationship between laboratory parameters on admission and prognosis of coronavirus disease 2019 (COVID-19) in maintenance hemodialysis patients, as well as providing a theoretical basis for clinical evaluation of prognosis and corresponding intervention measures. METHODS: Retrospective analysis was performed on the clinical data of 47 maintenance hemodialysis patients who infected with COVID-19 and admitted to our hospital. According to their clinical outcome, these patients were divided into a survival group (n = 38) and a fatality group (n = 9). Information on the general condition and laboratory parameters of the patients were collected. Laboratory parameters were compared between different groups. The area under the curve (AUC) was used to evaluate the prognosis of COVID-19 in maintenance hemodialysis patients. RESULTS: Statistically significant differences were observed in age, white blood cell count, neutrophil count, albumin, C-reactive protein (CRP), procalcitonin, and lactate dehydrogenase (LDH) on admission (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the values of AUC of CRP, neutrophil count, LDH, white blood cell count, albumin, and procalcitonin were 0.895, 0.813, 0.758, 0.757, 0.743, and 0.728, respectively. CONCLUSIONS: Laboratory parameters including CRP, neutrophil count, LDH, white blood cell count, albumin, and procalcitonin were predictive on the prognosis of maintenance hemodialysis patients with COVID-19. Among them, CRP was the strongest single predictive laboratory indicator.

Bed-sided short-duration renal replacement therapy provide a possible option to treat non-critical coronavirus disease 2019 in maintenance hemodialysis patients in public health crisis.

HD care may experience great stress with the coronavirus disease 2019 (COVID-19) pandemic. A modified HD modality named bed-sided short-duration renal replacement therapy (BSRRT) was used in noncritical maintenance HD (MHD) patients diagnosed with COVID-19 in Wuhan due to extreme situation. To determine the safety and efficacy as a substitution for intermittent HD (IHD), we conducted this study. We used the data of 88 noncritical COVID-19 MHD patients collected from 65 medical units at the hospitals in Wuhan, China, from January 1 to March 10, 2020. t-test, Wilcoxon rank sum test, and Fisher exact probability method were used to compare the baseline characteristics, treatment, and death. Log-rank test and Cox regression multivariate analysis was used to compare the survival of noncritical patients who were transferred to BSRRT modality versus those who were continued on the IHD. Univariate analysis showed the level of reported fatigue symptom at present, bilateral lung computed tomography infiltration and steroid treatment differed between the two groups. The outcome of death of the two groups did not show significant differences in univariate analysis (P = .0563). Multivariate Cox regression analysis dialysis showed modality of treatment after COVID-19 diagnosis was not a significant predictor of death (P = .1000). These data suggest that for noncritical COVID-19 MHD patients, the transfer from IHD to BSRRT does not have significant difference in the risk of death compared with IHD group. This finding suggests this modified modality could be an option for the substitution for IHD during the COVID-19 pandemic period.

Clinical features of patients undergoing hemodialysis with COVID-19.

Hemodialysis patients are susceptible to coronavirus disease 2019 (COVID-19). The aim of this study was to describe the epidemiological, clinical characteristics, and mortality-related risk factors for those who undergoing hemodialysis with COVID-19. We conducted a retrospective study. A total of 49 hemodialysis patients with COVID-19 (Group 1) and 74 uninfected patients (Group 2) were included. For patients in Group 1, we found the median age was 62 years (36-89 years), 59.3% were male, and the median dialysis vintage was 26 months. Twenty-eight patients (57%) had three or more comorbidities and two patients (4%) died. The most common symptoms were fever (32.7%) and dry cough (46.9%), while nine patients (18.4%) were asymptomatic. Blood routine tests indicated lymphocytopenia, the proportion of lymphocyte subsets was generally reduced, and chest CT scans showed ground-glass opacity (45.8%) and patchy shadowing (35.4%). However, these findings were not specific to hemodialysis patients with COVID-19, and similar manifestations could be found in patients without SARS-CoV-2 infection. In conclusion, for hemodialysis patients with COVID-19, lymphocytopenia and ground-glass opacities or patchy opacities were common but not specific to them, early active treatment and interventions against nosocomial infection can significantly reduce the mortality and the risk of SARS-CoV-2 infection.

Serologic Detection of SARS-CoV-2 Infections in Hemodialysis Centers: A Multicenter Retrospective Study in Wuhan, China.

RATIONALE & OBJECTIVE: Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: From December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients. EXPOSURE: NAT and antibody testing results for SARS-CoV-2. OUTCOMES: Morbidity, clinical features, and laboratory and radiologic findings. ANALYTICAL APPROACH: Differences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results. RESULTS: Among 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure. LIMITATIONS: Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations. CONCLUSIONS: Half the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.

Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China.

BACKGROUND: Reports indicate that those most vulnerable to developing severe coronavirus disease 2019 (COVID-19) are older adults and those with underlying illnesses, such as diabetes mellitus, hypertension, or cardiovascular disease, which are common comorbidities among patients undergoing maintenance hemodialysis. However, there is limited information about the clinical characteristics of hemodialysis patients with COVID-19 or about interventions to control COVID-19 in hemodialysis centers. METHODS: We collected data retrospectively through an online registration system that includes all patients receiving maintenance hemodialysis at 65 centers in Wuhan, China. We reviewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 between January 1, 2020 and March 10, 2020. RESULTS: Of 7154 patients undergoing hemodialysis, 154 had laboratory-confirmed COVID-19. The mean age of the 131 patients in our analysis was 63.2 years; 57.3% were men. Many had underlying comorbidities, with cardiovascular disease (including hypertension) being the most common (68.7%). Only 51.9% of patients manifested fever; 21.4% of infected patients were asymptomatic. The most common finding on chest computed tomography (CT) was ground-grass or patchy opacity (82.1%). After initiating comprehensive interventions-including entrance screening of body temperature and symptoms, universal chest CT and blood tests, and other measures-new patients presenting with COVID-19 peaked at 10 per day on January 30, decreasing to 4 per day on February 11. No new cases occurred between February 26 and March 10, 2020. CONCLUSIONS: We found that patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high-risk settings during the epidemic. Increasing prevention efforts, instituting universal screening, and isolating patients with COVID-19 and directing them to designated hemodialysis centers were effective in preventing the spread of COVID-19 in hemodialysis centers.