EXPERIENCE IN THE USE OF NEUTRALIZING MONOCLONAL ANTIBODIES IN KIDNEY TRANSPLANT RECIPIENTS WITH COVID-19.

Therapy with neutralizing monoclonal antibodies (mAbs) is particularly relevant during COVID-19 outbreaks in patients at high risk of severe disease, including kidney transplant recipients (KTRs). Objective(s): to evaluate the efficacy and safety of neutralizing mAbs in KTRs with mild to moderate COVID-19. Materials and methods. The retrospective study included 99 KTRs who received inpatient treatment for COVID-19 between September 1 and December 31, 2021. Patients were 52.0 +/- 11.5 years old (M, 47.5%). Bamlanivimab/etesevimab combination drug at a dose of 700/1400 mg was used as mAbs. To evaluate the efficacy of mAbs therapy, two groups of patients were identified. Group 1 consisted of 33 KTRs who received mAbs as one of the therapy components, while group 2 consisted of 66 patients who received no mAbs. Discharge from the hospital or death was considered as the endpoint of follow-up. Results. In group 1, after the use of mAb, progression of pulmonary process was observed less frequently than in the control group with CT1-2 transformation to CT3-4 (9.1% vs. 30.3%, respectively, p < 0.01). Group 1 KTRs differed significantly from group 2 - lower need for ICU and ventilator care (6.1% vs. 27.3% and 3% vs. 19.8%, respectively). The groups were comparable by sex, age, body mass index, Charlson Comorbidity Index (CCI) and time after kidney transplant (KTx) at the onset of the disease and by aseline blood biochemistry parameter values at the time of hospitalization. Only C-reactive protein (CRP) and fibrinogen values were higher in the non-mAbs patients who were hospitalized later in the course of the disease (7.7 +/- 3.2 days versus 4.6 +/- 1.6 days in group 1, p < 0.001). The frequency of prescription of other therapies did not differ between the compared groups. Use of mAbs significantly reduced mortality from 19.7% in KTRs in group 2 to 3% in group 1 without adverse effect on graft function. Conclusion. The use of mAbs therapy in the early stages of COVID-19 in KTRs is safe, it prevents severe COVID-19, and reduces the incidence of adverse outcomes.Copyright © 2023 Russian Transplant Society. All rights reserved.

Experience in the use of neutralizing monoclonal antibo dies in kidney transp lant recipients withC OVID -19

Therapy with neutralizing monoclonal antibodies (mAbs) is particularly relevant during COVID-19 outbreaks in patients at high risk of severe disease, including kidney transplant recipients (KTRs). Objective: to evaluate the efficacy and safety of neutralizing mAbs in KTRs with mild to moderate COVID-19. Materials and methods. The retrospective study included 99 KTRs who received inpatient treatment for COVID-19 between September 1 and December 31, 2021. Patients were 52.0 +/- 11.5 years old (M, 47.5%). Bamlanivimab/etesevimab combination drug at a dose of 700/1400 mg was used as mAbs. To evaluate the efficacy of mAbs therapy, two groups of patients were identified. Group 1 consisted of 33 KTRs who received mAbs as one of the therapy components, while group 2 consisted of 66 patients who received no mAbs. Discharge from the hospital or death was considered as the endpoint of follow-up. Results. In group 1, after the use of mAb, progression of pulmonary process was observed less frequently than in the control group with CT1-2 transformation to CT3-4 (9.1% vs. 30.3%, respectively, p < 0.01). Group 1 KTRs differed significantly from group 2 - lower need for ICU and ventilator care (6.1% vs. 27.3% and 3% vs. 19.8%, respectively). The groups were comparable by sex, age, body mass index, Charlson Comorbidity Index (CCI) and time after kidney transplant (KTx) at the onset of the disease and by.aseline blood biochemistry parameter values at the time of hospitalization. Only C-reactive protein (CRP) and fibrinogen values were higher in the non-mAbs patients who were hospitalized later in the course of the disease (7.7 +/- 3.2 days versus 4.6 +/- 1.6 days in group 1, p < 0.001). The frequency of prescription of other therapies did not differ between the compared groups. Use of mAbs significantly reduced mortality from 19.7% in KTRs in group 2 to 3% in group 1 without adverse effect on graft function. Conclusion. The use of mAbs therapy in the early stages of COVID-19 in KTRs is safe, it prevents severe COVID-19, and reduces the incidence of adverse outcomes.

Monoclonal antibodies to the interleukin-6 receptor in the treatment of COVID-19 in patients with chronic kidney disease

Interleukin-6 (IL-6) plays a key role in the pathogenesis of COVID-19, which determines the indications for the therapeutic use of its antagonists. However, data on their effectiveness and optimal timing of appointment are contradictory. The question of the possibility of their use in patients with impaired kidney function has not been studied. The aim of the study is to evaluate the efficacy and safety of the use of monoclonal antibodies to IL-6 receptors in COVID-19 in patients with chronic kidney disease (CKD) of stages 2-5 (predialysis) who do not need renal replacement therapy. Material and methods. A clinical retrospective uncontrolled single-center study included 45 patients (60% of men) with CKD stages 2-5 aged 22-95 years (median - 58 years) hospitalized with predominantly severe uncritical COVID-19 infection. Treatment of COVID-19 was carried out in accordance with the Interim guidelines for the prevention and treatment of new coronavirus infection of the Ministry of Health of Russian Federation. Results. The majority of patients (n=36;73.3%) had CKD stage 3b-5, CKD stage 2 was in 7 (15.5%) and stage 3a - in 5 (11.1%) patients. The median serum creatinine level (Cr) was 164 [131;292] mumol/l, glomerular filtration rate (GFR) was 30 [13;49] ml/min/1.73 m2, CRP 67.5 [37.2;106.75] mg/l. The introduction of monoclonal antibody to IL-6 receptors led to a decrease in the activity of the infectious process (CRP 1.55 [0.33;4.15] mg/l, p<0.001), regression of pneumonia, which did not require mechanical ventilation and hospitalization in the intensive care unit. According to the decision of the medical commission, patients were injected with monoclonal antibodies to IL-6 receptors: tocilizumab (n=36;80%), levilimab (n=2;4.4%), combined therapy with two drugs (n=7;15.5%). Therapy with IL-6 antagonists did not have a negative effect on kidney function. The levels of Cr decreased on average from 224.3+/-145.2 mmol/l at admission to 160+/-92.55 mmol/l at discharge (p<0.001), GFR increased from 32.6+/-20.9 ml/min/1.73 m2 at admission to 53+/-31.7 ml/min/1.73 m2 at discharge (p<0.001). In the majority of patients (n=36, 80%) GFR has risen, and only in 9 (20%) cases it remained approximately at the same low level. No serious adverse events have been reported with the use of IL-6 antagonists, as well as concomitant infectious complications. No deaths have been reported. The median length of stay in bed was 14 [10;19] days. Conclusion. The results of the study allow us to state that in patients with CKD, monoclonal antibodies to IL-6 receptors have a good safety profile and can be successfully used in moderate and severe forms of COVID-19, regardless of the state of kidney function.Copyright © 2022 by the authors.

COVID-19 in hemodialysis patients

Objective. Evaluation of clinical observation, the course, the risk factors, and treatment options for SARS-CoV-2 infection in hemodialysis patients with end-stage chronic kidney disease. Material and methods. The retrospective, single-center, uncontrolled study involved 231 patients (132 M/99 W) aged 61.7+/-14.7 years with COVID-19 diagnosed. The SPSS software package was used for statistical analysis. Results. 72 (31.2%) of patients died, 68 (94.4%) of them had ARDS as the main cause of death. Comparative analysis in groups with favorable and unfavorable outcomes of the disease showed that age (68.1+/- 13.2 years vs 58.7+/-14.5 years, p<0.0001) and the comorbidity index (8.8+/-2.2 vs 6.2+/-2.6, p<0.0001) were significantly higher in those who have died compared to survivors. According to CT data, they were more likely to have 3rd or 4th-degree lung damage (72.2 vs 36.5%, p<0.0001), and the minimum oxygen saturation index: 67.6+/-12.8 and 87.8+/-10.9%, respectively (p<0.0001). Somorbidity index and the need for invasive ventilation were independent predictors of the fatal outcome of COVID-19. Early administration of monoclonal antibodies to IL-6 (in the first 3 days after hospitalization) in patients with a low prevalence of the pulmonary process (CT stage 1-2) was associated with a significantly lower frequency of fatal outcome. Conclusions. SARS-CoV-2 infection in HD patients is characterized by a high rate of mortality. Predictors of severe disease in this population are comorbidity index and the need for invasive ventilation.Copyright © Infectious Diseases: News, Opinions, Training.

The use of neutralizing monoclonal antibodies against SARS-CoV-2 in hemodialysis patients

Patients with end-stage kidney disease undergoing hemodialysis have one of the highest COVID-19 mortality rates. The use of innovative methods capable of optimizing their treatment outcomes is important for clinical practice. Aims - to investigate the efficacy and safety of neutralizing monoclonal antibodies in COVID-19 patients treated with hemodialysis. Material and methods. We conducted a retrospective controlled single-center study with 102 COVID-19 patients on maintenance hemodialysis involved (M: 67;65.7%;W: 35;34.3%), aged 57.2+/-15.3 years. PCR-detected SARS-CoV-2 infection was diagnosed in all patients. Neutralizing monoclonal antibodies were administered to 69 patients, who formed the study group (group 1). The control group included 33 patients (group 2). The combination of bamlanevimab and etesevimab was the most frequent therapy used (in 59 patients). Results. In the course of the disease, group 1 patients, compared to those of group 2, had statistically significantly higher blood oxygen saturation values (94.2+/-5.7 vs 89.8+/-10.7);they required less frequent oxygen support (29.0 vs 54.5%) and ICU treatment (18.8 vs 48.5%), respectively. Fatal outcomes occurred in 4 (5.8%) of 69 patients who received neutralizing antibodies and in 6 (18.2%) of 33 patients who did not receive the therapy, p<0.05. Except for one patient, all other patients in both groups developed an unfavorable outcome due to progressive lung damage. However, only 4 of 6 (2/3) patients with progressive lung damage died in group 1, whereas the similar course of the disease proved fatal in all cases in group 2. Conclusion. The use of neutralizing monoclonal antibodies in hemodialysis patients is safe and effective when the drugs are administered early, the pulmonary process progression is insignificant and dominant SARSCoV-2 variants are sensitive to them.Copyright © 2022 Tomsk Polytechnic University, Publishing House. All rights reserved.

The use of neutralizing monoclonal antibodies against SARS-CoV-2 in hemodialysis patients

Patients with end-stage kidney disease undergoing hemodialysis have one of the highest COVID-19 mortality rates. The use of innovative methods capable of optimizing their treatment outcomes is important for clinical practice. Aims – to investigate the efficacy and safety of neutralizing monoclonal antibodies in COVID-19 patients treated with hemodialysis. Material and methods. We conducted a retrospective controlled single-center study with 102 COVID-19 patients on maintenance hemodialysis involved (M: 67;65.7%;W: 35;34.3%), aged 57.2±15.3 years. PCR-detected SARS-CoV-2 infection was diagnosed in all patients. Neutralizing monoclonal antibodies were administered to 69 patients, who formed the study group (group 1). The control group included 33 patients (group 2). The combination of bamlanevimab and etesevimab was the most frequent therapy used (in 59 patients). Results. In the course of the disease, group 1 patients, compared to those of group 2, had statistically significantly higher blood oxygen saturation values (94.2±5.7 vs 89.8±10.7);they required less frequent oxygen support (29.0 vs 54.5%) and ICU treatment (18.8 vs 48.5%), respectively. Fatal outcomes occurred in 4 (5.8%) of 69 patients who received neutralizing antibodies and in 6 (18.2%) of 33 patients who did not receive the therapy, p<0.05. Except for one patient, all other patients in both groups developed an unfavorable outcome due to progressive lung damage. However, only 4 of 6 (2/3) patients with progressive lung damage died in group 1, whereas the similar course of the disease proved fatal in all cases in group 2. Conclusion. The use of neutralizing monoclonal antibodies in hemodialysis patients is safe and effective when the drugs are administered early, the pulmonary process progression is insignificant and dominant SARSCoV-2 variants are sensitive to them. © 2022 Tomsk Polytechnic University, Publishing House. All rights reserved.

The use of therapeutic plasma exchange in the severe forms of COVID-19 in patients with renal fаilure

Cytokine release syndrome plays a key role in the pathogenesis of COVID-19. Therapeutic plasma exchange (TPE) by removing pathogenic cytokines, can favorably influence the course of severe forms of this disease. However, conclusive studies on this issue are still lacking. Only descriptions of individual clinical cases or small cohort studies have been published. There are no data on the use of TPE in patients with renal failure in the literature. The study aims to evaluate the effect of TPE in the severe forms of COVID-19 in patients with advanced renal failure. Material and Methods: a retrospective, uncontrolled, observational study enrolled 211 patients aged 60,4±13,2. 90.5% of them received renal replacement therapy: 66.8% – hemodialysis, 9.5% – peritoneal dialysis, 14.2% renal transplant recipients with moderate to severe dysfunction, and 9.5% had acute kidney injury on chronic kidney disease that did not require dialysis treatment. Results. All patients were divided into 2 groups: 124 (58.8%) patients (treated from 01.07. to 15.12.2020), who received TPE (TPE group), and 87 (41.2%) patients (observed from 01.04. to 30.06.2020), who did not treat with TPE (control group). The condition of patients in both groups at admission was approximately comparable. The clinical picture of the disease was dominated by severe pneumonia. There were no significant differences in inflammatory markers: both groups had no significant differences in levels of CRP, ferritin, lactate dehydrogenase, or D-dimer. The groups also did not differ significantly in lymphopenia, thrombocytopenia, and azotemia. The mortality rate in the group of patients who did not receive TPE was 73.5%, while in the TPE group it was 45.16% (p<0.001). Among patients on chronic dialysis, the mortality rate in the control subgroup was 74.6%, and in the TPE subgroup – 44.15% (p<0.001). Conclusion:therapeutic plasma exchange is an efficient approach to the treatment of severe forms of COVID-19 in patients with advanced renal failure. Its effect, however, may be limited by the risk of death due to uremia. © 2022 JSC Vidal Rus. All rights reserved.

Monoclonal antibodies to the interleukin-6 receptor in the treatment of COVID-19 in patients with chronic kidney disease

Interleukin-6 (IL-6) plays a key role in the pathogenesis of COVID-19, which determines the indications for the therapeutic use of its antagonists. However, data on their effectiveness and optimal timing of appointment are contradictory. The question of the possibility of their use in patients with impaired kidney function has not been studied. The aim of the study is to evaluate the efficacy and safety of the use of monoclonal antibodies to IL-6 receptors in COVID-19 in patients with chronic kidney disease (CKD) of stages 2-5 (predialysis) who do not need renal replacement therapy. Material and methods. A clinical retrospective uncontrolled single-center study included 45 patients (60% of men) with CKD stages 2-5 aged 22-95 years (median - 58 years) hospitalized with predominantly severe uncritical COVID-19 infection. Treatment of COVID-19 was carried out in accordance with the Interim guidelines for the prevention and treatment of new coronavirus infection of the Ministry of Health of Russian Federation. Results. The majority of patients (n=36;73.3%) had CKD stage 3b-5, CKD stage 2 was in 7 (15.5%) and stage 3a - in 5 (11.1%) patients. The median serum creatinine level (Cr) was 164 [131;292] μmol/l, glomerular filtration rate (GFR) was 30 [13;49] ml/min/1.73 m2, CRP 67.5 [37.2;106.75] mg/l. The introduction of monoclonal antibody to IL-6 receptors led to a decrease in the activity of the infectious process (CRP 1.55 [0.33;4.15] mg/l, p<0.001), regression of pneumonia, which did not require mechanical ventilation and hospitalization in the intensive care unit. According to the decision of the medical commission, patients were injected with monoclonal antibodies to IL-6 receptors: tocilizumab (n=36;80%), levilimab (n=2;4.4%), combined therapy with two drugs (n=7;15.5%). Therapy with IL-6 antagonists did not have a negative effect on kidney function. The levels of Cr decreased on average from 224.3±145.2 mmol/l at admission to 160±92.55 mmol/l at discharge (p<0.001), GFR increased from 32.6±20.9 ml/min/1.73 m2 at admission to 53±31.7 ml/min/1.73 m2 at discharge (p<0.001). In the majority of patients (n=36, 80%) GFR has risen, and only in 9 (20%) cases it remained approximately at the same low level. No serious adverse events have been reported with the use of IL-6 antagonists, as well as concomitant infectious complications. No deaths have been reported. The median length of stay in bed was 14 [10;19] days. Conclusion. The results of the study allow us to state that in patients with CKD, monoclonal antibodies to IL-6 receptors have a good safety profile and can be successfully used in moderate and severe forms of COVID-19, regardless of the state of kidney function. © 2022 by the authors.

[Criteria for the optimal use of interleukin-6 receptor blockers in patients with COVID-19].

AIM: To determine the criteria for the optimal use of IL-6 receptor blockers in patients with COVID-19 community-acquired pneumonia based on predictors of adverse outcomes. MATERIALS AND METHODS: The single-center, non-randomized prospective study included 190 patients with community-acquired pneumonia caused by coronavirus 2 between the beginning of March and the end of May 2020. Of these, 89 patients received tocilizumab and 101 patients received sarilumab. The study inclusion criterion for the patient was indications for initiating therapy with one of the inhibitors of IL-6 receptors (anti-IL-6R) according to the Interim guidelines (versions 4 and 5). The exclusion criterion was the need to re-prescribe genetically engineered biological therapy (GEBT). The severity of the patient's condition was assessed according to the early warning score (NEWS2), the volume of lung tissue lesions was assessed according to computed tomography (CT). Laboratory monitoring included counting the absolute (abs) number of lymphocytes, serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), D-dimer, lactate dehydrogenase, fibrinogen. Statistical data processing was conducted by nonparametric methods using the IBM SPSS Statistics V-22 software. RESULTS: The phenotype of a patient with a negative outcome prognosis was described: a male patient over 50 years of age with aggravated premorbid background (with cardiovascular diseases, obesity and/or chronic renal disease), lung lesion CT 34, saturation less than 93% upon inhalation of atmospheric air, persisting for 2448 hours after GEBT. According to the blood test, lymphopenia was below 1000 U/L and CRP levels were above 50 mg/L. The laboratory parameters and clinical picture of the patient progressively worsened after 911 days of illness, regardless of the use of Anti-IL-6R. The features of patients monitoring when administering IL-6 receptor blockers have been determined. CONCLUSION: IL-6 receptor blockers should be administered to patients hospitalized with severe COVID-19 before the development of hyperinflammatory reactions. The optimal "therapeutic window" is 78 days of illness.

[COVID-19 in haemodialysis patients: result analysis of the first year of the pandemic].

BACKGROUND: Present concepts of the novel coronavirus infection prognosis in haemodialysis (HD) patients are rather controversial. There is little information on therapy efficiency and safety in such patients. We studied COVID-19 course specifics, prognostic factors associated with fatal outcomes, therapy efficiency and its transformation at different stages of the pandemic first year. MATERIALS AND METHODS: Single-centre retrospective uncontrolled study included 653 COVID-19 HD-patients treated at Moscow City Nephrology Centre from April 1 to December 31, 2020. RESULTS: This period mortality rate was 21.0%. Independent predictors of COVID-19 unfavourable outcome in HD patients were pulmonary lesion extension (CT grades 34), high comorbidity index, and mechanical ventilation. Approaches to COVID-19 treatment modified significantly at different periods. Immunomodulatory drugs (monoclonal antibodies to IL-6, corticosteroids) were used largely at later stages. With tocilizumab administration, mortality was 15.1%, tocilizumab together with dexamethasone 13.3%; without them 37.8% (р0,001). Tocilizumab administration in the first 3 days after hospitalization of patients with CT grades 12 was associated with more favourable outcomes: 1 out of 29 died vs 6 out of 20 (tocilizumab administered at later periods); p0.04. There was no significant difference in death frequency in patients with CT grades 34 depending on tocilizumab administration time. CONCLUSION: COVID-19 in HD patients can manifest in a severe course with unfavourable outcome. It is urgent to identify reliable disease outcome predictors and develop efficient treatment in this population.

Novel coronavirus infection and hemodialysis: course and predictors of unfavorable outcome

In the context of the COVID-19 pandemic, patients with end-stage CKD receiving hemodialysis replacement therapy (HD) were at risk of SARS-CoV-2 infection due to the specifics of treatment and the immunodeficiency state caused by uremia. The aim of the study was to analyze the characteristics of the course, prognostically unfavorable factors, and outcome of COVID-19 in HD patients of the second wave of the pandemic. Materials and methods: a retrospective study was carried out on the material of observations of 325 HD patients infected with SARS-CoV-2 in the period from 09/01/2020 to 12/31/2020. The patients' age was 60.1±14.0 years. The duration of HD treatment was 30.0 (9.5;66.0) months. The endpoint was taken as the discharge from the hospital or death. Results: in 264 out of 325 (81.2%) patients, the diagnosis of COVID-19 was confirmed by the identification of SARS-CoV-2 RNA. CT scan of the chest showed signs of viral pneumonia in all patients. Mortality was 15.1% (49 out of 325 pts). In 79.7% of patients, the cause of death was ARDS. Comparative analysis showed that patients with a fatal outcome (group 2) were older (69.2±10.6 years) than patients with a successful course (group 1) of the disease (58.5±13.9 years), and differed in higher comorbidity index (7.8±1.9 versus 5.9±2.2, respectively). SpO2 in groups 2 and 1 was 65.2±10.1% and 92.1±6.4%, respectively (p<0.001). In the deceased patients, anemia, leukocytosis, thrombocytopenia, and hypoalbuminemia were significantly more pronounced, as well as indicators of GGT, alkaline phosphatase, ferritin, CRP, LDH, and D-dimer. In the fatal group, the proportion of patients with a procalcitonin level of more than 2 ng/ml was also higher. In multivariate analysis, only high comorbidity index and the need for mechanical ventilation were the independent predictors of the unfavorable outcome. In the group of patients with the favorable outcome, the combined therapy with immunobiological drugs and dexamethasone were used significantly more often than in the deceased group, while the frequency of their “isolated” use in the compared groups was comparable. Conclusions: COVID-19 in HD patients is characterized by severe course and high mortality. Independent predictors of an unfavorable outcome of the disease were a high comorbidity index and the need for invasive lung ventilation. Early use of immunobiological drugs and dexamethasone in combination with anticoagulants increases the effectiveness of treatment of severe forms of SARS-CoV-2 infection in HD patients. © 2021 JSC Vidal Rus. All rights reserved.

SARS-CoV-2 infection in kidney transplant recipients

The study aimed to assess the clinical course and risk factors for adverse outcomes, as well as the treatment options for COVID-19 in renal transplant recipient (RTR). Patients and methods: a retrospective study included 279 RTRs (M 60.9%, age 49.9±10.9 years), infected with SARS-CoV-2 from 01.04.2020 to 30.11.2020. After confirmation of COVID-19 by PCR and chest CT, MMF/Aza were canceled. In severe cases, the CNI dose was minimized while that of CS was increased. Observation endpoints: hospital discharge/recovery or death. Results: SARS-CoV-2 was identified in 84.2% of RTRs. In almost 90% of patients, the COVID-19 was confirmed by CT data. Duration after transplantation at the time of infection was 54.0 (14.0;108.0) months, in 17.6% of cases it was 6 months or less. 223/79.9% RTRs were treated in the hospital. The period from the onset of the disease to the hospitalization was 6.8±4.5 days. Severe lung damage (>50%) occurred in 43.1% RTRs;45.3% of patients required respiratory support. Hospital mortality was 13.9%, overall mortality was 11.1%. The most common cause of death (93.5%) was acute respiratory distress syndrome (ARDS). The risk factors associated with an unfavorable outcome were a high comorbidity index, the severity of the pulmonary lesion, the degree of graft dysfunction at the onset of the disease, decreased SpO2 and the use of mechanical ventilation, as well as anemia, leukocytosis, lymphocytopenia, and hypoalbuminemia, increased levels of creatinine, AST, CRP, LDH, and D-dimer, interleukin-6 and procalcitonin. Scr during the course of the disease increased from 171.6±78.0 μM to 221.5±121.3 μM (p<0.01) with no signs of acute rejection. In 2 recipients with severe graft failure at the time of infection with SARS-CoV-2, HD was resumed from the moment of hospitalization. We were unable to identify the effect of hydroxychloroquine on the outcome of COVID-19. At the same time, mortality in patients with hydroxychloroquine use was higher than in recipients treated with immunobiological drugs: 25.6% and 11.4%, respectively, p<0.02. When immunomodulators were combined with dexamethasone, mortality decreased to 4.8%. The independent factors of adverse outcome were high levels of procalcitonin (p<0.019) and mechanical ventilation (p<0.001). Conclusion: COVID-19 in RTRs is characterized by a severe course and high mortality, which necessitates hospitalization of the majority of infected patients. An increase in procalcitonin levels and the need for mechanical ventilation were independent predictors of an unfavorable outcome of COVID-19. © 2021 JSC Vidal Rus. All rights reserved.

Covid-19: Relationship with kidney diseases: Literature review

COVID-19 is a severe acute respiratory disease caused by the SARS-CoV-2 virus. Although COVID-19 is characterized mainly by diffuse alveolar damage and acute respiratory failure, in some cases COVID-19 may acquire extra-respiratory features, including renal dysfunction that has existed earlier or developed de novo. The reasons for the extra-respiratory manifestations are biological properties of SARS-CoV-2 based on its multiple organ tropism. It has been shown that at least 50% of patients hospitalized for COVID-19 have proteinuria, hematuria, and signs of renal dysfunction, which in some cases reaches the degree of acute kidney injury (AKI). Here we present a review that discusses the clinical aspects and possible pathophysiological mechanisms of kidney damage in COVID-19. It is believed that renal damage observed in this disease is the result of a complex mechanism induced directly or indirectly by SARS-CoV-2 with the development of acute kidney injury. Two main pathophysiological mechanisms of kidney damage in COVID-19 are discussed. The first of them is the direct cytopathic effect of SARS-CoV-2 on the renal epithelium with the development of acute tubulonecrosis. The second mechanism is the cytokine storm syndrome that results from hyperactivation of the immune system with the development of acute renal and multiorgan infl ammatory damage accompanied by hypoxia, persistent hypotension, rhabdomyolysis, hyperactivation of the coagulation cascade, and microcirculation disorders. From a clinical point of view, it should be noted that signs of kidney damage are associated with an increase in the severity of COVID-19 and a poor outcome of the disease, and the prognosis becomes the worst with the development of AKI (the risk of death may increase by 5.3 times). The incidence of COVID-19 in patients with ESRD is higher than in the general population. The most typical for these patients is a severe course of the disease, which determines the increased mortality in comparison with the general population, caused by a respiratory failure with hyperactive infl ammation, cytokine storm, hemodynamic, and multiple organ failures. © 2021 JSC Vidal Rus. All rights reserved.

COVID-19 in hemodialysis patients

Objective. Evaluation of clinical observation, the course, the risk factors, and treatment options for SARS-CoV-2 infection in hemodialysis patients with end-stage chronic kidney disease. Material and methods. The retrospective, single-center, uncontrolled study involved 231 patients (132 M/99 W) aged 61.7±14.7 years with COVID-19 diagnosed. The SPSS software package was used for statistical analysis. Results. 72 (31.2%) of patients died, 68 (94.4%) of them had ARDS as the main cause of death. Comparative analysis in groups with favorable and unfavorable outcomes of the disease showed that age (68.1± 13.2 years vs 58.7±14.5 years, p<0.0001) and the comorbidity index (8.8±2.2 vs 6.2±2.6, p<0.0001) were significantly higher in those who have died compared to survivors. According to CT data, they were more likely to have 3rd or 4th-degree lung damage (72.2 vs 36.5%, p<0.0001), and the minimum oxygen saturation index: 67.6±12.8 and 87.8±10.9%, respectively (p<0.0001). Сomorbidity index and the need for invasive ventilation were independent predictors of the fatal outcome of COVID-19. Early administration of monoclonal antibodies to IL-6 (in the first 3 days after hospitalization) in patients with a low prevalence of the pulmonary process (CT stage 1-2) was associated with a significantly lower frequency of fatal outcome. Conclusions. SARS-CoV-2 infection in HD patients is characterized by a high rate of mortality. Predictors of severe disease in this population are comorbidity index and the need for invasive ventilation. © Infectious Diseases: News, Opinions, Training.

Risk factors of adverse outcome of COVID-19 and experience of tocilizumab administration in patients on maintenance hemodialysis due to diabetic kidney disease

BACKGROUND: Patients with Type 2 Diabetes (T2DM) and patients on maintenance hemodialysis (MHD) are at a high risk of adverse clinical course of COVID-19. To date, the causes of high mortality in these groups are not fully understood. Data about peculiarity of clinical course and Tocilizumab (TCZ) administration in patients with T2DM receiving MHD due to outcome of diabetic kidney disease (DKD) are not yet highlighted in current publications. AIMS: Identification of risk factors (RF) of adverse COVID-19 outcome and evaluation of TCZ administration in patients with T2DM receiving MHD due to DKD. MATERIALS AND METHODS: The patients treated in Moscow City Hospital №52 were included in retrospective observational study. The observation period was from 04.15 to 07.30 2020. The study endpoints were the outcomes of hospitalization - discharge or lethal outcome. Data were collected from electronic medical database. The following independent variables were analysed: gender, age, body mass index, time from the onset of symptoms to hospital admission, cardiovascular and general comorbidity (Charlson Index, CCI), cardiovascular event (CVE) during hospitalization, treatment in ICU, mechanical ventilation (MV), degree of lung damage according to CT data, level of prandial glycemia at admission, MHD-associated parameters (vintage, type of vascular access, frequency of complications). The autopsy reports were evaluated for the purpose of lethal structure investigation. In a subgroup treated TCZ the time from symptoms onset to TCZ administration and number of laboratory indicators were evaluated. RESULTS: 53 patients were included, mean age 68 ±9 y, males - 49%. General mortality in observation cohort was 45%, mortality in ICU - 81%, mortality on MV - 95%. High cardiovascular and general comorbidity was revealed (mean CCI - 8,3 ±1,5 points). The causes of outcomes according to autopsy reports data: CVE 37,5% (among them - acute myocardial infarction during hospitalization), severe respiratory failure - 62,5%. The independent predictors of lethal outcome were: MV (OR 106;95% CI 11,5-984;р <0,001), 3-4 degree of lung damage according to CT data (ОR 6,2;95% CI 1,803-21,449;р = 0,005), CVE during hospitalization (ОR 18,9;95% CI 3,631-98,383;р <0,001);CCI ≥10 points (ОR 4,33;95% CI 1,001-18,767;р = 0,043), level of prandial glycemia at admission ≥10 mmol/l (ОR 10,4;95% CI 2,726-39,802;р <0,001). For risk identification of upcoming lethal outcome a predictive model was created with the use of discovered RF as variables. The predictive value of this model is 92,45% (positive prognostic value - 96,5%, negative prognostic value - 87,5%). In TCZ treated subgroup the laboratory markers of adverse outcome were detected with application of correlation analysis. Among them: increasing level of CPR 24-48 hours before lethal outcome (r = 0,82), the reduction of lymphocytes count after TCZ administration (r = -0,49), increasing of leukocytes and further reduction of lymphocytes count 24-48 hours before lethal outcome (r = 0,55 и r = -0,52, resp.)). CONCLUSIONS: The number of RF of adverse COVID-19 outcome in patients with T2DM receiving MHD due to DKD are identified. CVE is one of the leading causes of mortality in study cohort. According to our experience the preventive (instead of rescue) strategy of TCZ administration should be used.

Clinical course and approaches to therapy in kidney transplant recipients with the novel COVID-19 disease

The COVID-19 pandemic has had global consequences due to the wide spread of the infection in the world, lack of currently proven effective therapy, resistance to treatment in a significant proportion of those affected and, as a result, high mortality, especially among high-risk groups. Kidney transplant recipients with coronavirus-induced pneumonia are among the most problematic categories of patients. This patient cohort experiences a severe form of the disease, taking into account a combination of risk factors, such as long-term immunosuppression, comorbid background of patients, and consequences of chronic kidney disease. Difficulties in the management of recipients with COVID-19 are also down to the limitation of the use of drugs due to adverse drug-drug interactions. Objective: to analyze the course of COVID-19 disease in organ recipients, to assess the factors influencing the prognosis of the disease, and to optimize approaches to treatment of these patients. Materials and methods. During the period from April 15, 2020 to June 15, 2020, 68 people (38 men and 30 women) were hospitalized at our clinic. Their average age was 49.7 ± 9.2 years (22 to 70 years). COVID-19 diagnosis was verified by PCR. Multispiral computed tomography (MSCT) scans showed that in all cases, there were characteristic lung lesions of varying degrees of severity. Results. Out of the 68 people treated, 61 (89.8%) were discharged with recovery, 7 patients died. So, the mortality rate was 10.2%. This indicator did not depend on age and gender. First of all, mortality depended on the severity of lung lesions: at CT4 it was 43% (3/7), at CT3 - 11.1% (4/36), there were no deaths in patients with CT2. There was a 100% mortality among patients who received mechanical ventilation. Severity of graft dysfunction was also an important prognostic factor: with moderate dysfunction, this indicator was 8% (5/63), while with severe dysfunction it was 40% (2 out of 5). Besides, a more severe prognosis was observed in patients in the early post-transplant period: 5 patients out of the 7 who died of COVID-19 (71%) lived for less than a year after kidney allotransplantation (ATP). Mortality in this category of patients was 24%, while in the period from 1 to 5 years, this indicator was 13.6%;no deaths were recorded among patients with a period of over 5 years after ATP. All patients received antibacterial (levofloxacin or azithromycin) and antiviral (hydroxychloroquine) therapy. In all cases, the baseline immunosuppressive therapy (IST) was changed, including withdrawal of mycophenolic acid preparations, minimization of the calcineurin inhibitor dose (target concentration 1.5-3 ng/ mL for tacrolimus and 30-50 ng/mL for cyclosporine), and increase in prednisolone dose by 5 mg relative to the current one. About 78% of cases received pathogenetic therapy with anti-interleukin monoclonal antibodies (mainly tocilizumab). These patients also received intravenous immunoglobulin at 10 g average dose. In severe COVID-19 accompanied in by clinical and laboratory signs of thrombotic microangiopathy 22% of cases, plasma exchange sessions and/or infusion of fresh frozen plasma and dose adjustment of low molecular weight heparins were performed. Conclusions. COVID-19-induced pneumonia in kidney transplant recipients is characterized by a high risk of progressive lung damage and respiratory failure. Mortality in COVID-19 is independent of gender and age, but correlates with post-transplantation period, severity of pneumonia, and severity of graft dysfunction. The need for mechanical ventilation is associated with an extremely unfavorable prognosis of the disease. Пандемия COVID-19 повлекла за собой глобальные последствия, обусловленные широким распространением инфекции в мире, отсутствием в настоящее время доказанной эффективной терапии, резистентностью к проводимому лечению у значительной части заболевших и, как следствие, значительной летальностью, особенно в группах высокого риска. Одной из наиболее проблемных категорий больных являются реципиенты почечного трансплантата с коронавирусной пневмонией. Данная когорта больных имеет серьезный прогноз заболевания с учетом совокупности факторов риска: длительной иммуносупрессии, коморбидного фона больных, последствий хронической болезни почек. Трудности ведения трансплантированных пациентов с СOVID-19 также обусловлены ограничением применения лекарственных препаратов из-за неблагоприятных межлекарственных взаимодействий. Целью исследования было проанализировать течение заболевания COVID-19 у пациентов, перенесших трансплантацию органов, и оценить факторы, влияющие на прогноз заболевания, оптимизировать подходы к лечению этих больных. Материалы и методы. За период с 15.04.20 по 15.06.20 в стационаре нашей клиники было пролечено 68 человек (38 мужчин и 30 женщин). Средний возраст составил 49,7 ± 9,2 года (от 22 до 70 лет). Диагноз COVID-19 был верифицирован методом ПЦР. По данным МСКТ во всех случаях выявлялось характерное поражение легких различной степени тяжести. Результаты. Из 68 человек 61 (89,8%) был выписан с выздоровлением, 7 пациентов умерли. Таким образом, летальность составила 10,2%. Этот показатель не зависел от возраста и пола. В первую очередь, летальность зависела от тяжести легочного поражения: при КТ4 составила 43% (3/7), при КТ3 - 11,1% (4/36), у пациентов с КТ2 летальных исходов не было. Среди пациентов, получавших ИВЛ, летальность составила 100%. Важным прогностическим фактором оказалась также выраженность дисфункции трансплантата: при умеренной дисфункции этот показатель составил 8% (5/63), тогда как при выраженной дисфункции он был равен 40% (2 из 5). Помимо этого, более тяжелый прогноз отмечался у пациентов в ранние сроки после АТП: у 5 пациентов из 7 умерших от СOVID-19 (71%) срок после АТП составлял менее года. Летальность у этой категории пациентов составила 24%, тогда как в сроки от 1 до 5 лет этот показатель был равен 13,6%, а среди пациентов со сроком после АТП более 5 лет летальных исходов не отмечалось. Всем пациентам проводилась антибактериальная (левофлоксацин либо азитромицин) и противовирусная (гидроксихлорохин) терапия. Во всех случаях проводилось изменение базисной ИСТ, включавшее отмену препаратов микофеноловой кислоты, минимизацию дозы ингибиторов кальциневрина (целевая концентрация 1,5-3 нг/мл для такролимуса и 30-50 нг/мл для циклоспорина) и повышение дозы преднизолона на 5 мг относительно текущей дозировки. В 78% случаев проводилась патогенетическая терапия антиинтерлейкиновыми моноклональными антителами (преимущественно тоцилизумабом). Этим пациентам также вводился внутривенный иммуноглобулин в средней дозе 10 г. При тяжелом течении СOVID-19, сопровождавшемся в 22% случаев клинико-лабораторными признаками тромботической микроангиопатии, проводились сеансы плазмообмена и/или инфузии свежезамороженной плазмы и коррекция дозы низкомолекулярных гепаринов. Выводы. Пневмония, индуцированная СOVID-19, у пациентов после трансплантации почки характеризуется высоким риском прогрессирования легочного процесса и дыхательной недостаточности. Летальность при СОVID-19 не зависит от пола и возраста, однако коррелирует со срокомпосле трансплантации, тяжестью пневмонии и выраженностью дисфункции РАТ. Перевод на ИВЛ сопряжен с крайне неблагоприятным прогнозом заболевания.

COVID-19 in solid organ transplant recipients: initial report from national multicenter observational study "ROKKOR-recipieni"

We herein present our initial report from «ROKKOR-recipient», a national multicenter observational study. The prevalence, risk factors, clinical manifestations and outcomes ofthe novel coronavirus disease 2019 (COVID-19) in solid organ transplant recipients receiving immunosuppressive therapy were investigated. The study enrolled 251 COVID-19 patients (220 kidney recipients, 7 liver recipients, 1 liver-kidney recipient, and 23 heart recipients). The subjects came from 20 regions in Russia. The symptoms, clinical presentation, imaging and lab test results, therapy and outcomes of COVID-19 were described. It was established that solid organ transplant recipients with COVID-19 have a higher risk of developing adverse events. Predictors of adverse events include associated cardiovascular diseases, pulmonary diseases, diabetes, and kidney failure. Symptoms of the disease include dyspnea, rash and catarrhal signs, as well as initial low blood oxygen saturation (SpO₂ <92%), leukocytosis (white blood cell count >10 х 10⁹/L), elevated creatinine levels (>130 mumol/L) and a marked decrease in glomerular filtration rate, requiring hemodialysis. Performing organ transplant surgery in COVID-19 does not increase the risk of adverse events but could save the lives of waitlisted terminally ill patients. В статье представлены первые результаты национального многоцентрового исследования «РОККОР-реципиент», имевшего целью изучить распространенность, факторы риска, клинические проявления и исходы новой коронавирусной инфекции (COVID-19) у реципиентов солидных органов, получающих иммуносупрессивную терапию. В исследование включен 251 пациент (220 реципиентов почки, 7 реципиентов печени, 1 реципиент печени и почки, 23 реципиента сердца) из 20 регионов России c COVID-19. Описаны симптомы, клинические проявления, результаты инструментальных и лабораторных обследований, терапия и исходы коронавирусной инфекции. Выявлено, что наличие трансплантированного органа повышает риск нежелательных событий на фоне COVID-19, предикторами которых являются сопутствующие сердечно-сосудистые, легочные заболевания, сахарный диабет и почечная недостаточность, наличие в качестве симптомов манифестации заболевания одышки, сыпи и катаральных явлений, а также исходно низкая сатурация кислорода (SpO₂ <92%), лейкоцитоз более 10 х 10⁹/л, повышение уровней креатинина более 130 мкмоль/л и значимое снижение скорости клубочковой фильтрации, требующее проведения гемодиализа. Выполнение трансплантации органов на фоне пандемии COVID-19 не повышает риск развития нежелательных событий у реципиентов, но позволяет спасти жизни больных с терминальными заболеваниями, включенных в лист ожидания.

Eculizumab in treatment of ANCA-associated vasculitis complicated with Covid-19 Clinical observations

Vasculitis associated with the antineutrophilic cytoplasmic antibodies (ANCA) is an autoimmune systemic severe, often life-threatening, disease characterized by necrotizing infl ammation of small vessels. In 75-90% of cases of ANCA-associated vasculitis (AAV), a rapidly progressive pauci-immune necrotizing crescentic glomerulonephritis develops. Despite current treatment with high-dose glucocorticoids and either cyclophosphamide or rituximab, patients have a nine-fold increased mortality risk during the fi rst year of disease compared with healthy subjects. This high mortality is attributed mainly to infections and vasculitis activity. Recent data suggest that the activation of the complement system, and in particular the alternative complement pathway, plays a signifi cant role in the pathogenesis of AAV. It has been suggested that neutrophils primed by infection or pro-infl ammatory cytokines release properdin, which activates an alternative complement cascade with cleavage of C5 into C5a and C5b. Anaphylatoxin C5a binds to receptors on the surface of neutrophils, enhancing their priming and activation and thus contributing to the infl ammation. The randomized clinical trial showed that the selective C5a-receptor inhibitor avakopan was effective in the treatment of AAV. However, avacopan is currently not available in the everyday clinical practice. On the other hand, reports showing successful usage of monoclonal antibody against C5 eculizumab in severe AAV had been published. Here we present four cases of AAV complicated by COVID-19, for which conventional therapy with cy?lophosphamide could not be applied due to the particularly high risk of serious infectious complications, and eculizumab was used off-label by decision of the medical council and special commission. Taking this decision, we took into account data demonstrating the role of complement activation and, in particular, C5a in the pathogenesis of acute lung disease, induced by pathogenic viruses. Moreover, the successful usage of eculizumab in severe COVID-19 was reported recently. Thus, we sought to apply an approach aimed simultaneously at the pathogenetic mechanisms of both AAV and viral lung damage. © 2020 JSC Vidal Rus. All rights reserved.

Covid-19-associated cardiac damage in patients on maintenance hemodialysis. Case reports and review of the literature

A brief review of current publications about incidence, outcomes and mechanisms of cardiovascular complications in patients with the new coronaviral disease (COVID-19) is given. The possibility of direct deleterious viral effect on the myocardium, negative consequences of cytokine storm, the role of hypoxemia complicating acute respiratory distress syndrome (ARDS), myocardial infarction 1,2 type (MI 1, 2), hypercoagulation, systolic disfunction of right ventricle due to ARDS, recurrent pulmonary embolism (PE) and cardiotoxic effects of drug therapy is discussed. Three case reports of cardiac injury in patients on maintenance hemodialysis (MHD) with COVID-19 are presented. The first case demonstrated MI 2 type due to ischemic imbalance in a patient with severe ARDS in the absence of obstructive coronary arteries lesion. The second case represented coexistent affection of heart as a result of viral myocarditis and cardiotoxic effect of Azithromycin and Plaquenil co-administration. The viral myocarditis was proven by postmortem histological and immunohistochemical tests. The third case demonstrated the diagnostic quest in a patient with recurrent dyspnea due to sequential severe ARDS, viral hemorrhagic exudative pericarditis with cardiac tamponade and PE progression. Currently three basic phenotypes of cardiac injury are distinguished: permanent elevation of myocardial damage markers, MI 1, 2 Type and viral myo/pericarditis. Of note, the course of COVID-19 in patients on MHD is more complicated in comparison with the general population. The initial vulnerability of these patients is determined not only by severe co-morbidity. Some interconfounding pathophysiological processes same to COVID-19 are critically important for the understanding of the current state of the art. The crucial role of persistent chronic inflammation, coagulopathy, pulmonary hypertension, permanent hemodynamic stress and fluctuation of volemic status should also be taken into consideration. MHD by itself is a powerful risk factor which overburdens the course of COVID-19. Статья содержит краткий обзор текущих публикаций, касающихся распространенности, исходов и механизмов формирования сердечно-сосудистых осложнений у пациентов с новой коронавирусной инфекцией (COVID-19). Обсуждаются возможность прямого повреждающего действия вируса на миокард, негативные последствия цитокинового шторма, роль гипоксемии, осложняющей течение острого респираторного дистресс синдрома (ОРДС), развитие инфарктов миокарда 1 и 2 типов (ИМ 1, 2), гиперкоагуляции, систолической дисфункции правого желудочка на фоне ОРДС, рецидивирующей тромбоэмболии легочной артерии (ТЭЛА) и кардиотоксические эффекты медикаментозной терапии. Представлено описание трех клинических случаев поражения сердца у пациентов, находящихся на лечении программным гемодиализом (ПГД). В первом случае продемонстрировано развитие ИМ 2 типа вследствие ишемического дисбаланса у пациента с тяжелым ОРДС без обструктивного поражения коронарных артерий сердца. Во втором случае показано сочетанное поражение сердца у пациента с верифицированным вирусным миокардитом и кардиотоксическим эффектом совместного применения азитромицина и плаквенила. Вирусный миокардит был подтвержден при аутопсии с последующим проведением гистологического и иммунногистохимического исследований. Третий случай демонстрирует диагностический поиск причин рецидивирующего одышечного синдрома у пациента с последовательным развитием тяжелого ОРДС, вирусного геморрагического экссудативного перикардита, осложненного тампонадой сердца, и ТЭЛА. В обсуждении клинических случаев подчеркивается широкое распространение поражения сердца при COVID-19. Выделяется 3 основных фенотипа вовлечения сердца в патологический процесс: стойкое повышение концентрации маркеров повреждения миокарда, развитие ИМ 1, 2 типов и вирусные мио/перикардиты. Отмечается, что COVID-19 протекает значительно тяжелее у пациентов на ПГД по сравнению с общей популяцией. Стартовая уязвимость диализных пациентов для новой коронавирусной инфекции обусловлена не только исходно тяжелой коморбидностью. Крайне важным является наличие взаимоотягощающих патофизиологических процессов, синергичных таковым при COVID-19. Решающую роль играют персистирующие в диализной популяции процессы хронического воспаления, коагулопатия, легочная гипертензия, перманентный гемодинамический стресс и колебания волемического статуса. ПГД как таковой представляется мощным фактором риска, отягощающим течение COVID-19.

Risk factors of adverse prognosis in patients on maintenance hemodialysis with Covid-19. Focus on cardivascular comorbidity. Single center experience

Background: patients on maintenance hemodialysis (MHD) are at high risk of adverse clinical course of COVID-19. Study objective: analysis and evaluation of heart condition and risk factors of adverse clinical course of COVID-19 in patients on MHD. Materials and methods: 85 patients were included in retrospective observational hospital-based study in Moscow City Hospital 52 from 04.15 to 06.02.2020. The endpoints were results of hospitalization: discharge or lethal outcome. Several demographic, anamnestic, clinical and instrumental indicators were analyzed. Among them: gender, age, general and cardiovascular comorbidity (Charlson index, CCI), the type of vascular dialysis access, the etiology of ESKD, dialysis vintage, body mass index (BMI), cardiovascular events (CVE) in the course of hospital stay (myocardial infarction, MI, pulmonary embolism, PE, and others), ICU admission, mechanical ventilation (MV), the results of echocardiography and lung computed tomography (CT). Odds ratio (OR) was calculated and logistic regression with step-by-step algorithm was applied to assess risk factors of adverse outcomes of COVID-19 in cohort under study. Results: The mean age was 65±13 years (59%, males). Mortality in whole cohort was 43.5% (75%, in ICU patients, and 89% in patient on MV). The concomitant diseases were hypertension (92%), ischemic heart disease (54%), recent MI (19%), chronic heart failure (55%), permanent atrial fibrillation (20%) and diabetes (45%). Mean CCI was 6.6±2.4. Obesity was observed in 33% of cases. No statistical confidence was found in CCI (6.3±2.4 points (survivors) vs 7.0±2.3 points, p>0.05), BMI (26.8±5.3 kg/m2 vs 27.1±5.8 kg/m2, p>0.05). The total number of CVE - 20 (4 vs 16, p=0.019), MI - 10%, PE - 6%. No statistically significant difference was found in LV myocardial mass index - average index 140±33 g/m2 (138±36 g/m2 vs 143±30 g/m2, p>0.05), LA volume index - median 35 (33;40) ml/m2 - 35 (33;40) ml/m2 vs 36 (35;38) ml/m2, p>0.05. In 35% systolic disfunction of right ventricle was observed with no difference between groups. The average index of left ventricle ejection fraction (LVEF) was 53±9% (54±6% vs 50±10%, p=0.019). The median of pulmonary artery systolic pressure - 40 mm Hg (30;53) (38 (30;52) mm Hg vs 42 mm (34;53) Hg, p>0.05). The highest OR was calculated for following parameters: MV (OR=31.95% CI 18-121, p=0.0001), CVE (OR=8.3, 95% CI=2.5-2.8, p=0.0001), CCI ≥6 (OR=4.8, CI=1.6-11.2, p=0.002) and LVEF ≤45% (OR=3-8, 95%, CI=1.3-11,3, p=0.018). Regression logistic analysis demonstrated a strong relationship of lethal outcome with MV (OR=18.0) and CVE (OR=8.5), the moderate relationship with male gender (OR=2.1) and CCI (OR=1.25). Conclusion: the predictors of adverse outcome of COVID-19 in patients on MHD are the need for MV, CVE, CCI ≥6, decline of LVEF ≤45%, male gender. Введение: пациенты на программном гемодиализе (ПГД) формируют группу высокого риска неблагоприятного течения COVID-19. Цель исследования: анализ структурно-функциональных особенностей сердца и факторов риска (ФР) неблагоприятного исхода COVID-19 у пациентов на ПГД. Материалы и методы: в ретроспективное наблюдательное исследование с 15.04 по 02.06.20 г. включено 85 пациентов. Конечные точки исследования - исходы госпитализации (выписка/летальный исход). Сбор данных осуществлялся путем анализа электронных историй болезни. Независимые переменные: пол, возраст, сердечно-сосудистая, общая коморбидность (индекс Charlson, ССI), тип сосудистого доступа, причина тПН, винтаж диализа, индекс массы тела (ИМТ), кардиоваскулярное событие (КВС) в ходе госпитализации (острый инфаркт миокарда (ИМ), тромбоэмболия легочной артерии (ТЭЛА) и др.), лечение пациента в ОРИТ, проведение ИВЛ, данные МСКТ ОГК и эхокардиографического исследования. Для оценки ФР неблагоприятного исхода рассчитывалось отношение шансов (ОШ), построена модель логистической регрессии с пошаговым алгоритмом включения и исключения предикторов. Результаты: средний возраст 65±13 лет, мужчины - 59%. Общая летальность - 43,5%, среди пациентов ОРИТ - 75%, на ИВЛ - 89%. Сопутствующие заболевания: артериальная гипертензия (92%), ишемическая болезнь сердца (54%), постинфарктный кардиосклероз (19%), хроническая сердечная недостаточность (55%), постоянная форма фибрилляции предсердий (20%), сахарный диабет (45%). Средний CCI - 6,6±2,4 баллов, ИМТ >30 кг/м2 - у 33%. Не выявлено статистически значимой разницы в группах исхода по ССI (6,3±2,4 балла (выжившие) vs 7,0±2,3 балла, p>0,05), ИМТ (26,8±5,3 кг/м2 vs 27,1 ±5,8 кг/м2, p>0,05). Общее количество КВС - 20 (4 vs 16, p=0,019), ОИМ - в 10% случаев, ТЭЛА - в 6%. Не выявлено статистически значимой разницы в группах исхода по индексу массы миокарда ЛЖ (средний показатель 140±33 г/м2 (138±36 г/м2 vs 143±30 г/м2, p>0,05), индексу объема левого предсердия - медиана 35 (33;40) мл/м2 (35 (33;40) мл/м2 vs 36 (35;38) мл/м2, p>0,05). У 35% выявлена систолическая дисфункция правого желудочка. Средние показатели % фракции выброса ЛЖ (ФВЛЖ) - 53±9%, (54±6% vs 50±10%, p=0,019). Медиана систолического давления в легочной артерии - 40 mm Hg (30;53), с тенденцией к более высоким показателям в группе летальных исходов - 38 (30;52) mm Hg vs 42 (34;53) mm Hg, p>0,05. Получены следующие отношения шансов (ОШ): ИВЛ (ОШ 31;95% ДИ 8-121;p=0,0001), КВС (ОШ 8,3;95% ДИ 2,5-2,8;p=0,0001), CCI ≥6 баллов (ОШ 4,8;95% ДИ 1,6-11,2;p=0,002), ФВЛЖ ≤45% (ОШ 3,8;95% ДИ 1,3-11,3;p=0,018). Регрессионный логистический анализ выявил сильную связь летального исхода с пребыванием на ИВЛ (ОШ 18,0) и с КВС (ОШ 8,5), умеренную - с мужским полом (ОШ 2,1) и CCI (ОШ 1,25). Выводы: предикторами неблагоприятного течения COVID-19 у пациентов на ПГД являются: потребность в ИВЛ, КВС в ходе госпитализации, CCI ≥6 баллов, ФВЛЖ ≤45%, мужской пол.