COVID-19 疫苗和腎臟疾病： COVID-19疫苗接種對慢性腎臟病患者腎功能之影響

COVID-19 vaccines and kidney disease: The impact of COVID-19 vaccination on renal function in patients with chronic kidney disease

莊宗芳(Tzung-Fang Chuang)

指導教授 ： 黃建寧

共同指導教授 ： 白佳原(Jar-Yuan Pai)

中山醫學大學/醫學院/醫學研究所/博士(2022年)

https://doi.org/10.6834/csmu202200110

摘要

研究目的：慢性腎臟病(chronic kidney disease, CKD)患者是新冠肺炎嚴重感染的高危險族群，感染新冠肺炎(coronavirus disease of 2019, COVID-19) 較一般民眾容易發展為重症。而疫苗接種能有效提升病患之抵抗力，即使感染也能降低重症及死亡的風險。雖然已有許多文獻指出，COVID-19疫苗對慢性腎臟病患者是安全的，仍有報告指出COVID-19 疫苗接種可能引發腎病症候群或急性腎損傷，然而疫苗與急性腎損傷之間的因果關係需要進一步證實。文獻回顧得知，目前尚無關於 COVID-19 疫苗接種對慢性腎病患者腎功能影響的世代研究。所以我們進行了一項回顧性研究，以調查疫苗接種後腎功能的變化。
研究方法及資料：本研究以台灣中部某家醫院的慢性腎臟病患為對象，觀察其於2021年期間疫苗接種前後，其腎絲球過濾率(estimated glomerular filtration rate, eGFR)及尿液蛋白質肌酸酐比值(urine protein creatinine ratio, UPCR)變化幅度，對照組為前一年度相同病患同一期間的eGFR及UPCR變化，比較是否有顯著差異。採院內病歷與資料回溯方式蒐集資料。以曾於這家醫院腎臟科門診追蹤且曾接受該醫院醫療團隊施打COVID-19疫苗之慢性腎臟病人為對象。共回溯318位慢性腎臟病患，分析了疫苗前後估計的腎絲球濾過率和尿蛋白質肌酐酸比值，並與前一年的變化進行了比較。
研究結果：COVID-19疫苗接種前後 eGFR 的平均變化為1.52±0.63 (SE) mL/min/1.73m2。相比之下對照年度eGFR的平均變化為-0.95±0.74 mL/min/1.73m2。配對樣本 t 檢驗顯示它們的平均差異為2.47 mL/min/1.73m2，p值為 0.007 (95% CI 0.69-4.25)。接種 COVID-19 疫苗前後 UPCR 的平均變化為296.16±73.35 mg/g。對照年度UPCR的平均變化為-40.32±51.30 mg/g。配對樣本 t 檢驗顯示它們的平均差異為 336.48 mg/g，p值 <0.001 (95% CI 165.14-507.83)。
結論：CKD 患者在COVID-19疫苗接種後可發現 eGFR 和 UPCR 增加。

關鍵字

COVID-19 ； 疫苗 ； 慢性腎臟病 ； 腎絲球過濾率

並列摘要

Objective：Patients with chronic kidney disease (CKD) are high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Newly developed SARS-CoV-2 vaccines are effective against infection during the COVID-19 pandemic. The vaccines are safe for chronic kidney patients, with only sporadic cases of nephrotic syndrome or acute kidney injury (AKI) having been reported following COVID-19 vaccination. However, the causal relationship between vaccines and AKI remain to be identified. To our knowledge, there is no cohort study about the impact of COVID-19 vaccination on renal function of patient with CKD. Therefore, we conducted a retrospective study to investigate changes in renal function after vaccination.
Methods and Materials：318 Taiwanese CKD patients in stage 3 to 5 received 2 doses of COVID-19 vaccine. Estimated glomerular filtration rates (eGFR) and urine protein creatinine ratios (UPCR) before and after vaccines were analyzed with compare to usual change in the preceding year.
Results：The average changes in eGFR before and after COVID-19 vaccine administration was 1.52±0.63 (SE) mL/min/1.73m2. The average changes in eGFR of the control year were -0.95±0.74 mL/min/1.73m2. Paired sample t-test revealed mean differences of them were 2.47 mL/min/1.73m2 with p-value 0.007 (95% CI 0.69-4.25). The average changes in UPCR before and after COVID-19 vaccine administration were 296.16±73.35 mg/g. The average changes in UPCR of the control year was -40.32±51.30 mg/g. Paired sample t-test revealed mean differences of them were 336.48 mg/g with p value <0.001 (95% CI 165.14-507.83).
Conclusion：Increases in eGFR and UPCR were found in CKD patients following COVID-19 vaccination.

並列關鍵字

Chronic kidney disease ； COVID-19 ； vaccine ； SARS-CoV-2

參考文獻

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