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.

Table 2 Post-coronavirus disease condition clinical outcomes in kidney transplant recipients

Ref.	Setting and design	Population	Definition/timing of PCC	Key outcomes	Risk factors/notable points
Malinowska et al[14], 2021	Longitudinal cohort of KTR from north Poland with prior COVID-19; 6-month assessment of symptoms and HRQoL	67 KTR	“Post-COVID-19 syndrome” defined as persistent symptoms ≥ 12 weeks; follow-up at median 6 months	About 70% fulfilled criteria for post-COVID syndrome; fatigue, myalgia, cognitive complaints and sleep disturbance were common. Significant decline in HRQoL (EQ-5D-5 L, EQ-VAS) vs pre-COVID, especially pain/discomfort and anxiety/depression domains	Older age and a higher Charlson Comorbidity Index are associated with post-COVID syndrome. Authors compare burden with haemodialysis cohorts and the general population, suggesting KTR and HD both show disproportionate long-COVID-related QoL loss
Basic-Jukic et al[15], 2021	Single-centre prospective cohort of KTR surviving acute COVID-19; early post-infection follow-up	104 KTR	Prolonged symptoms or clinical complications at a median of 64 days post-diagnosis; not strictly WHO-PCC but early PASC	45% had prolonged symptoms or clinical complications; 71% had lab abnormalities (e.g., elevated D-dimer, inflammatory markers). Decline in eGFR and higher rejection episodes in those with more severe acute disease	Older age, lower baseline eGFR and clinical complications during acute COVID-19 are associated with poorer composite outcomes; calcineurin inhibitor dose reduction is associated with better outcomes in this cohort
Basic-Jukic et al[15], 2021 (“Late Effect in KTR” study)	Longer-term follow-up of KTR after early-wave COVID-19, stratified by severity	About 150 KTR with prior COVID-19, followed up to 24 months	Not symptom-based PCC; focuses on late graft and patient outcomes after COVID-19	Severe acute COVID-19 is associated with higher late mortality, graft loss, and larger eGFR decline compared to mild/moderate disease. Symptom persistence is less central than structural outcome signals	Suggests that in KTR, “long COVID” can be biochemical/structural (eGFR decline, rejection, graft loss) as well as symptomatic, and that acute severity imprints a long-term trajectory
Shafiekhani et al[16], 2023	Prospective cohort of hospitalised COVID-19 patients; KTR vs non-transplant controls, 6-month follow-up	148 KTR, 100 non-KTR	Post-COVID complications (clinical + radiological + functional) at 6 months	KTR had a higher prevalence of post-COVID complications than controls, including dyspnoea, fatigue and radiographic lung changes, plus more rehospitalizations	Risk factors for complications in KTR included CKD, hypertension, prior cerebrovascular disease and diabetes. Emphasises interaction between transplant-related immunosuppression and classic vascular comorbidity
Amorim et al[17], 2022	Large multicentre survey of KTR with confirmed COVID-19 infection; 3-month follow-up	780 KTR	Long COVID is defined as ≥ 1 organic symptom persisting at 3 months	27%-28% met long COVID criteria. Fatigue, dyspnoea, myalgia and cognitive complaints are the most frequent. 17% had not returned to work at 3 months	The main independent predictor of long COVID was the number of symptoms during the acute infection. No clear association with baseline immunosuppression pattern. Provides a large, real-world estimate of long COVID burden in KTR
Zahradka et al[18], 2025	Nationwide survey of KTR with prior COVID-19; latent-class modelling of symptom clusters	596 KTR, median follow-up about 1 year	WHO-aligned PCC criteria; clustering of symptom profiles	33.7% met PCC criteria. Eight distinct phenotypes identified (fatigue-dominant, cardiorespiratory, neurocognitive, musculoskeletal, etc.). Many patients had overlapping clusters	Risk: More severe acute COVID-19, higher BMI, ongoing corticosteroid use. Male sex appeared protective (OR = 0.69). Highlights that long COVID in KTR is heterogeneous, not a single syndrome
Morená et al[21], 2024	Prospective SOTR cohort (kidney, liver, heart, lung) in Spain in an Omicron-dominant, highly vaccinated setting	Mixed SOTR; substantial KTR subset	PASC is defined at > 12 weeks post-infection	PASC is still frequent but somewhat lower than early-wave reports; fatigue and dyspnoea predominate	Vaccination and Omicron seem to shift the severity spectrum, but do not abolish PASC. KTR behave similarly to other SOTR with regard to symptom profiles
Sandoval et al[24], 2025	Multicentre SOT cohort (including KTR) evaluating self-reported long COVID and risk factors	Mixed SOT; KTR an important subgroup	Patient-reported long COVID several months post-infection	Long COVID prevalence in SOT is broadly comparable to high-risk general populations; symptom clusters are similar (fatigue, dyspnoea, cognitive issues)	More severe acute disease, female sex, and psychological comorbidity are associated with PASC; the specific effect of immunosuppression intensity is less clear

BMI: Body mass index; OR: Odds ratio; COVID-19: Coronavirus disease 2019; eGFR: Estimated glomerular filtration rate; HD: Hemodialysis; HRQoL: Health-related quality of life; KTR: Kidney transplant recipients; QoL: Quality of life; SOT: Solid organ transplant; SOTR: Solid organ transplant recipients; PASC: Post-acute sequelae of coronavirus disease-19; PCC: Post-coronavirus disease condition; WHO-PCC: World Health Organization-post-coronavirus disease condition criteria; EQ-5D-5 L: EuroQol-5-dimension 5-level; EQ-VAS: EQ-visual analog scale.