Long-term Impact of COVID-19 amongst maintenance hemodialysis patients

Chawki, Sylvain; Buchard, Albert; Sakhi, Hamza; Dardim, Karim; El Sakhawi, Karim; Chawki, Mokhtar; Boulanger, Henri; Kofman, Tomek; Dahmane, Djamal; Rieu, Philippe; Attaf, David; Ahriz-Saksi, Salima; Masoumi, Afshin; Diddaoui, Ali Zineddine; Fromentin, Luc; Michaut, Patrick; Nebbad, Rachida; Desassis, Jean-François; Nicolet, Laurence; Sohier-Attias, Julie; Besson, Frederic; Boula, Remy; Hafi, Ali; Ghazali, Abderrahmane; Lamriben, Larbi; Arezki, Adem; Dupuis, Emmanuel; Rifard, Mohamad-Khair; Joly, Dominique; Attias, Philippe; El Karoui, Khalil

BACKGROUND: Maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COVID-19. However, long-term consequences of this disease in the MHD population are poorly described. We report the clinical presentation, outcome and long-term follow-up of MHD patients affected by COVID-19, in a multicentric cohort from the Paris, France area. METHODS: Retrospective analysis of clinical presentation and long-term follow-up of MHD patients affected by COVID-19 in 19 MHD centers in the Paris, France area. RESULTS: In this cohort of 248 patients with an initial mortality rate of 18%, age, comorbidities, dyspnea and previous immunosuppressive treatment were associated with death <30d. Among the 203 surviving patients following the acute phase, long-term follow-up (median 180d) was available for 189 (93%) patients. Major adverse events occurred in 30 (16%) patients during follow-up, including 12 deaths (6%) after a median of 78d from onset of symptoms. Overall, cardiovascular events, infections and gastrointestinal bleeding were the main major adverse events. Post-COVID-19 cachexia was observed in 25/189 (13%) patients. Lower initial albuminemia was significantly associated with this cachexia. No reinfection with SARS-CoV-2 was observed. CONCLUSION: This work demonstrates the long-term consequences of COVID-19 in MHD patients, highlighting both initial and long-term severity of the disease, including severe cachexia.