Shadows of infection: Post-coronavirus disease condition and outcome patterns in patients receiving dialysis and kidney transplant recipients

Table 1 Post-coronavirus disease condition clinical outcomes in dialysis patients

Ref.	Setting and design	Population	Definition/timing of PCC	Key outcomes	Risk factors/notable points
Belkacemi et al[6], 2022	National registry-based cohort of all chronic dialysis patients with COVID-19 in 2020; survey at 6 months	1217 dialysis survivors with complete 6-month symptom data	LLCS at 6 months = any of: Extreme fatigue, weight loss > 5%, respiratory symptoms, tachycardia, chest/joint/muscle pain, anosmia/ageusia, neuro-cognitive issues, PTSD, depression, anxiety	17.7% had ≥ 1 LLCS at 6 months. Symptoms mainly fatigue, psychological and cardiorespiratory complaints	Higher odds of LLCS with hospitalisation (OR = 1.64) and ICU stay (OR = 5.03). Each additional year on dialysis, diabetes, overweight, and obesity are all independently associated with LLCS
Och et al[9], 2021	Single-centre longitudinal cohort of hospitalised maintenance HD patients with COVID-19, follow-up at 3- and 6-months post-discharge	79 HD survivors (out of 206 hospitalised; high in-hospital and early post-discharge mortality)	“Post-COVID-19 syndrome” = persistent/new symptoms beyond 12 weeks, assessed at 3 and 6 months	At 3 months, 93.7% had ≥ 1 persistent symptom; 72% had ≥ 3 symptoms. At 6 months, 81% still had ≥ 1 symptom and 53% had ≥ 3. Fatigue/muscle weakness, palpitations, sleep disturbance and nausea were common. Sustained deterioration in EQ-5D-5 L and EQ-VAS vs pre-COVID; dyspnoea burden remained higher at 6 months than baseline	Very frail, high comorbidity HD population. Persistent multi-symptom burden and impaired QoL out to 6 months despite some improvement. No specific multivariable risk model, but high pneumonia and oxygen requirement in the acute phase
Bouchari et al[10], 2025	Multicentre cohort of chronic HD patients across 9 centres; retrospective + interview-based assessment at about 3 months post-infection	163 chronic HD patients with documented COVID-19 infection	Long COVID ≥ 1 persistent symptom 2-3 months after infection, lasting ≥ 2 months and impacting daily function	68% met long COVID criteria; 29% had ≥ 3 symptoms. Fatigue (62%), anxiety (53%), arthralgia (40%), cough (33%), weight loss, sleep disturbance and anosmia are common	Long COVID is strongly associated with diabetes (adjusted OR = 3.8). Obesity, hospitalisation, oxygen therapy and corticosteroids were tracked with persistent fatigue, anxiety, dyspnoea and weight loss. Highlights heavy psychological symptom load (anxiety in > 50%)
Zhao et al[12], 2024	Prospective cohort of maintenance HD patients with COVID-19; telephone/clinic follow-up at 12 months	About 350-400 maintenance HD patients (exact number varies slightly by analysis)	Long COVID defined as per WHO-aligned criteria at 12 months: At least one persistent or new symptom starting in first 3 months and lasting ≥ 2 months	Long COVID prevalence around two-thirds at 12 months. Fatigue, sleep disturbance, dyspnoea, cognitive complaints and mood symptoms frequent; significant impact on HRQoL scales	Risk factors: Female sex, higher comorbidity burden, severe acute COVID-19, and markers of anxiety/depression associated with persistent symptoms. Vaccination appeared partly protective but did not eliminate long COVID
Bouwmans et al[13], 2024	Multicentre Dutch cohort of CKD stage 4-5, dialysis and KTR patients; PCC and symptom burden in 2022-2023 (largely Omicron, high vaccination)	779 patients with prior COVID-19; includes CKD stage 4-5, dialysis, and KTR strata	PCC as per WHO consensus (symptoms ≥ 3 months, lasting ≥ 2 months, no alternative diagnosis); symptom burden quantified	PCC prevalence: About 21% in dialysis, 24% in KTR, about 29% in non-dialysis CKD stage 4-5. Many had high symptom burden (multiple domains, fatigue prominent)	Dialysis and KTR patients had higher PCC-associated functional limitations than matched controls but broadly similar PCC prevalence between modalities, suggesting shared mechanisms (multimorbidity, inflammation) rather than transplant-specific effects alone

CKD: Chronic kidney disease; COVID-19: Coronavirus disease 2019; HD: Hemodialysis; HRQoL: Health-related quality of life; ICU: Intensive care unit; KTR: Kidney transplant recipients; LLCS: Long-lasting clinical symptoms; PCC: Post-coronavirus disease condition; PTSD: Post-traumatic stress disorder; QoL: Quality of life; WHO: World Health Organization; OR: Odds ratio; EQ-5D-5 L: EuroQol-5-dimension 5-level; EQ-VAS: EQ-visual analog scale.