key: cord-0989013-wym4efga authors: Hoxha, Elion; Suling, Anna; Turner, Jan Eric; Haubitz, Marion; Floege, Jürgen; Huber, Tobias B.; Galle, Jan-Christoph title: „Coronavirus-disease-2019“-Pandemie aus nephrologischer Perspektive date: 2021-06-09 journal: Internist (Berl) DOI: 10.1007/s00108-021-01078-x sha: f4e2fe2405f56533bd217f74755791ae1e7affb9 doc_id: 989013 cord_uid: wym4efga BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has also resulted in substantial challenges for nephrology worldwide. Patients with chronic kidney diseases are a particularly vulnerable patient group in this context and in severe courses of COVID-19 the kidneys are most frequently affected by organ failure after the lungs. MATERIAL AND METHODS: In order to reliably evaluate the prevalence and mortality of dialysis patients in Germany with respect to COVID-19, during the first wave in spring 2020 the German Society of Nephrology implemented a registry for dialysis patients. Weekly data on the number and course of dialysis patients affected by COVID-19 were recorded and analyzed. RESULTS: The prevalence of COVID-19 in dialysis patients in Germany developed in two waves, similar to the course of the pandemic in the general population. In spring the prevalence in dialysis patients reached 1.4% and considerably declined during the summer. In December during the second wave of the pandemic the prevalence again rose to 1.9%, despite comprehensively implemented hygiene measures in dialysis centers. Similar to other industrial nations, dialysis patients in Germany also showed a very high lethality of COVID-19 of up to 20%. CONCLUSION: Immediate consequences for hygiene measures in dialysis institutions as well as vaccination strategies and vaccination prioritization for this patient group and the personnel treating them can be derived from the high mortality in dialysis patients. A consequence of the frequent involvement of the kidneys during infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who had not previously suffered from advanced kidney disease should be the consistent nephrological aftercare. "Coronavirus-disease-2019"-Pandemie aus nephrologischer Perspektive Einleitung Die Coronavirus-disease-2019(COVID-19)-Pandemie hat die Nephrologie in mehrfacher Hinsicht vor besondere Herausforderungen gestellt. Eine hohe Rate an akutem Nierenversagen bei Patienten mit schweren Krankheitsverläufen mit und ohne Nierenvorerkrankungen sowie ihre ungünstige Prognose wurden bereits in der frühen Phase der Pandemie beschrieben [1, 2] . Chronische Nierenerkrankungen und insbesondere eine Dialysepflichtigkeit zählen zu den Risikofaktoren für eine schwer verlaufende COVID-19. Patienten mit chronischer Niereninsuffizienz weisen ein erhöhtes Risiko für eine Hospitalisierung aufgrund von COVID-19 auf, verglichen mit Patienten, die keine Einschränkung der Nierenfunktion haben [3] . Auch die Mortalität der COVID-19-Patienten, die hospitalisiert werden oder in Pflege-/ Alteneinrichtungen leben, ist deutlich erhöht, wenn sie an einer chronischen Niereninsuffizienz leiden [2, 4] . Mit Nierenerkrankungen als wichtigem Risikofaktor, dem akuten Nierenversagen als wesentlicher Organmanifestation und den Nieren als direktem Zielorgan des "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2, [5, 6] ) ist die Nephrologie im interdisziplinären Zusammenspiel wesentlich an der Bewältigung der gegenwärtigen COVID-19-Pandemie beteiligt. Die daraus abzuleitenden gesundheitspolitischen Konsequenzen, insbesondere die Impfpriorisierung dieser Patienten, werden im Folgenden diskutiert. Hämodialyse · COVID19-Dialyseregister · Prävalenz · Letalität · Impfung Coronavirus disease 2019 pandemic from a nephrological perspective Abstract Background. The coronavirus disease 2019 (COVID-19) pandemic has also resulted in substantial challenges for nephrology worldwide. Patients with chronic kidney diseases are a particularly vulnerable patient group in this context and in severe courses of COVID-19 the kidneys are most frequently affected by organ failure after the lungs. Material and methods. In order to reliably evaluate the prevalence and mortality of dialysis patients in Germany with respect to COVID-19, during the first wave in spring 2020 the German Society of Nephrology implemented a registry for dialysis patients. Weekly data on the number and course of dialysis patients affected by COVID-19 were recorded and analyzed. Results. The prevalence of COVID-19 in dialysis patients in Germany developed in two waves, similar to the course of the pandemic in the general population. In spring the prevalence in dialysis patients reached 1.4% and considerably declined during the summer. In December during the second wave of the pandemic the prevalence again rose to 1.9%, despite comprehensively implemented hygiene measures in dialysis centers. Similar to other industrial nations, dialysis patients in Germany also showed a very high lethality of COVID-19 of up to 20%. Immediate consequences for hygiene measures in dialysis institutions as well as vaccination strategies and vaccination prioritization for this patient group and the personnel treating them can be derived from the high mortality in dialysis patients. A consequence of the frequent involvement of the kidneys during infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who had not previously suffered from advanced kidney disease should be the consistent nephrological aftercare. Hemodialysis · COVID-19-Dialysis Registry · Prevalence · Lethality · Vaccination gleich zur Vorwoche keine Änderungen ergeben haben. Fehlende Werte in der ersten Woche werden als "0" angenommen. In jeder Woche wurden durchschnittlich 11 Die Letalität der COVID-19-Dialysepatienten in Deutschland war im Sommer 2020 mit über 20 %, bezogen auf die Anzahl der an COVID-19 erkrankten Dialysepatienten, sehr hoch und auf einem mit anderen Industrienationen vergleichbaren Niveau [9] [10] [11] [12] [13] [14] [15] [16] [17] . Diese hohe Letalität, die der COVID-19-Letalität in der Bevölkerungsgruppe mit dem höchsten Risiko in Deutschland (d. h. Personen über 80 Jahre) entspricht, weist auf die hohe Bedeutung von Präventivmaßnahmen zur Verhinderung von COVID-19 bei Dialysepatienten hin. Der Rückgang der Letalitäts-und der Genesungsrate der COVID-19-Dialysepatienten, bezogen auf die Gesamtzahl der COVID-19-Dialysepatienten im Herbst könnte Folge des raschen Anstiegs der Anzahl neuer COVID-19-Fälle, der noch nachhängenden Sterblichkeit der aktuellen Fälle und der insgesamt evtl. verminderten COVID-19-Letalität in der 2. Welle sein. Aufgrund der zeitlichen Verzögerung zwischen Krankheitsbeginn und -ausgang kann angenommen werden, dass der Anstieg der COVID-19-Prävalenz bis Ende Dezember im weiteren Verlauf zum Anstieg der Letalität der COVID-19-Dialysepatienten führen wird. 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