Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2023; 29(19): 3013-3026
Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.3013
Gastrointestinal manifestations of long-term effects after COVID-19 infection in patients with dialysis or kidney transplantation: An observational cohort study
Wiwat Chancharoenthana, Supitcha Kamolratanakul, Asada Leelahavanichkul, Wassawon Ariyanon, Sutatip Chinpraditsuk, Rattanaporn Saelim, Somratai Vadcharavivad, Weerapong Phumratanaprapin, Polrat Wilairatana
Wiwat Chancharoenthana, Supitcha Kamolratanakul, Weerapong Phumratanaprapin, Polrat Wilairatana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Asada Leelahavanichkul, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Wassawon Ariyanon, Cardiometabolic Centre, Department of Medicine, Bangkok Nursing Hospital, Bangkok 10500, Thailand
Sutatip Chinpraditsuk, Rattanaporn Saelim, Dialysis Center, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Somratai Vadcharavivad, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Chancharoenthana W and Kamolratanakul S designed the research study; Chancharoenthana W, Kamolratanakul S, Ariyanon W, Chinpraditsuk S, and Saelim R performed the research and collected data; Chancharoenthana W, Kamolratanakul S, Ariyanon W, and Chinpraditsuk S analysed the data; Chancharoenthana W and Kamolratanakul drafted the manuscript. Chancharoenthana W, Kamolratanakul S, Leelahavanichkul A, Vadcharavivad S, Phumratanaprapin W, and Wilairatana P edited the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Human Research Ethics Committee of Faculty of Tropical Medicine, Mahidol University, Thailand (MUTM 2022-081-01).
Informed consent statement: Informed consent for participation in interviews was obtained either written or verbally over the phone from all participants in the study.
Conflict-of-interest statement: There are no conflicts of interest to disclose.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Supitcha Kamolratanakul, MD, Assistant Professor, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Rd, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. supitcha.kam@mahidol.edu
Received: January 12, 2023
Peer-review started: January 12, 2023
First decision: February 4, 2023
Revised: February 13, 2023
Accepted: April 21, 2023
Article in press: April 21, 2023
Published online: May 21, 2023

Prolonged symptoms after corona virus disease 2019 (Long-COVID) in dialysis-dependent patients and kidney transplant (KT) recipients are important as a possible risk factor for organ dysfunctions, especially gastrointestinal (GI) problems, during immunosuppressive therapy.


To identify the characteristics of GI manifestations of Long-COVID in patients with dialysis-dependent or KT status.


This observational, prospective study included patients with COVID-19 infection, confirmed by reverse transcription polymerase chain reaction, with the onset of symptoms between 1 January 2022 and 31 July 2022 which was explored at 3 mo after the onset, either through the out-patient follow-up or by telephone interviews.


The 645 eligible participants consisted of 588 cases with hemodialysis (HD), 38 patients with peritoneal dialysis (PD), and 19 KT recipients who were hospitalized with COVID-19 infection during the observation. Of these, 577 (89.5%) cases agreed to the interviews, while 64 (10.9%) patients with HD and 4 (10.5%) cases of PD were excluded. The mean age was 52 ± 11 years with 52% women. The median dialysis duration was 7 ± 3 and 5 ± 1 years for HD and PD groups, respectively, and the median time post-transplantation was 6 ± 2 years. Long-COVID was identified in 293/524 (56%) and 21/34 (62%) in HD and PD, respectively, and 7/19 (37%) KT recipients. Fatigue was the most prevalent (96%) of the non-GI tract symptoms, whereas anorexia (90.9%), loss of taste (64.4%), and abdominal pain (62.5%) were the first three common GI manifestations of Long-COVID. Notably, there were 6 cases of mesenteric panniculitis from 19 patients with GI symptoms in the KT group.


Different from patients with non-chronic kidney disease, there was a high prevalence of GI manifestations of Long-COVID in dialysis-dependent patients and KT recipients. An appropriate long-term follow-up in these vulnerable populations after COVID-19 infection is possibly necessary.

Keywords: COVID-19, Kidney transplant, Post-acute COVID-19 syndrome, Long-COVID-19, Gastrointestinal, SARS-CoV-2

Core Tip: Prolonged symptoms after coronavirus disease 2019 (COVID-19) or prolonged symptoms after COVID-19 (Long-COVID) in dialysis-dependent patients and kidney transplant (KT) recipients are important as a possible risk factor for organ dysfunctions, especially gastrointestinal (GI) problems. In this study, we observed that a GI manifestation of Long-COVID is a frequent condition in patients with dialysis-dependence and kidney-transplant recipients. Long-COVID was significantly more prevalent in peritoneal dialysis patients than in hemodialysis patient or KT cases. We also found that patients who experienced either abdominal pain or diarrhea had a longer duration of other GI manifestations of Long-COVID, suggesting a need for closer observation of these patients during COVID-19 infection.