研究背景：透析患者屬於營養不良的高風險族群，而感染COVID-19後可能進一步加劇其營養不良的風險，在臨床上則觀察到透析患者在感染COVID-19後血紅素及透析間體重增加幅度都會較之前下降，綜觀近年研究，COVID-19對透析患者的影響包括顯著增加住院率和死亡率，且文獻指出，感染COVID-19後患者會產生嚴重的發炎反應，進而影響食慾並增加熱量消耗，這種對營養狀況的威脅甚至可能持續達一年之久。
研究目的：本研究旨在填補透析患者在COVID-19感染後營養狀態變化的文獻空白，追蹤透析患者感染COVID-19後一年營養狀態趨勢，探討COVID-19感染對透析患者營養狀態的影響，並找出其相關因素。
研究方法：採病歷回溯性縱貫設計，資料來源為台灣南部某醫學中心及地區醫院的門診血液透析及腹膜透析患者，追蹤患者在感染COVID-19後第1、3、6、9、12個月的營養狀況，以高齡營養風險指標 (Geriatric Nutritional Risk Index, GNRI) 評估患者的營養狀態，採用廣義估計方程式 (Generalized Estimating Equation, GEE) 進行分析，以考慮資料的相關性及時間效應，建立多元線性迴歸模型 (Linear Regression) 檢驗GNRI在各時間點之間的變化，使用感染前GNRI作為基準，計算感染後各時間點GNRI與基準值之間的迴歸係數（β值），另外針對每個自變項，分別與GNRI的變化進行單變項分析，進一步加入單變項分析篩選的共變數，評估調整後的時間效應。
研究結果：研究結果發現（一）在一整年的追蹤期間，感染後的第一個月營養不良風險顯著高於感染前；（二）感染後的第六個月其營養不良風險顯著低於感染前；（三）感染後第一個月發生營養不良的風險因子包含性別及透析模式；（四）感染後第六個月營養不良的影響因子包含透析模式及感染前的血清白蛋白。
結論/實務應用：本研究顯示，COVID-19感染對透析患者的營養狀態具有明顯影響，特別是在感染後的第一個月營養狀況明顯惡化，並於第三個月至第六個月逐漸恢復。研究亦指出，營養不良的風險因子會隨感染後時間變化而有所不同，感染前白蛋白較高者營養狀態相對穩定，顯示預先良好的營養基礎可能具保護作用。實務上，此結果可協助臨床醫療團隊針對高風險個案進行分層與早期營養介入，提升疫情期間透析患者的整體照護品質。未來建議可結合更多營養評估指標與多中心資料，進一步驗證本研究結果並擴大其應用性。

This study investigates the nutritional impact of COVID-19 infection on dialysis patients, a population already at high risk for malnutrition. Clinical observations have noted that following COVID-19 infection, dialysis patients often experience declines in hemoglobin levels and interdialytic weight gain. Recent literature highlights that COVID-19 significantly increases hospitalization and mortality rates among dialysis patients, with its systemic inflammatory response contributing to appetite loss and elevated energy expenditure, potentially affecting nutritional status for up to a year. To address the current gap in the literature, this study aimed to longitudinally assess nutritional trends over a one-year period following COVID-19 infection in dialysis patients and identify related risk factors. Using a retrospective cohort design, data were collected from hemodialysis and peritoneal dialysis outpatients at a medical center and regional hospital in southern Taiwan. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI) at 1, 3, 6, 9, and 12 months post-infection. Generalized Estimating Equations (GEE) were used to account for data correlation and time effects, and multiple linear regression models assessed GNRI changes from baseline. Univariable analyses identified factors associated with nutritional changes, which were further adjusted in multivariable models. The results revealed that the risk of malnutrition was significantly higher in the first month after infection and significantly lower by the sixth month. Risk factors for early post-infection malnutrition included sex and dialysis modality, while predictors at six months included dialysis modality and baseline serum albumin. This study demonstrates that COVID-19 infection significantly disrupts the nutritional status of dialysis patients, particularly during the first month, with gradual recovery observed by the sixth month. The temporal variation in risk factors emphasizes the importance of timely and individualized nutritional intervention. Patients with higher pre-infection albumin levels showed greater nutritional stability, suggesting a protective effect of good baseline nutritional status. These findings provide valuable guidance for clinical teams to identify high-risk patients and implement early nutritional support, and future research should include broader nutritional indicators and multicenter data to validate and extend these findings.

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