The Longitudinal Evolution of Post–COVID-19 Outcomes Among Hemodialysis Patients in Turkey
Savaş Öztürk, Kenan Turgutalp, Mustafa Arıcı, Numan Görgülü, Halil Zeki Tonbul, Necmi Eren, Vedat Gençer, Mehmet Deniz Aylı, İrem Pembegül, Mürşide Esra Dölarslan, Zeynep Ural, Hülya Çolak, Tuba Elif Özler, Özgür Can, Mehmet Emin Demir, Orçun Altunören, Bülent Huddam, Kürşad Öneç, Bülent Demirelli, Zeki Aydın, Eda Altun, Selma Alagöz, Yavuz Ayar, Zeynep Ebru Eser, Bayram Berktaş, Zülfükar Yılmaz, Eser Uslu Ates, Enver Yüksel, Gizem Kumru Sahin, Merve Aktar, Egemen Cebeci, Belda Dursun, Sibel Yücel Koçak, Abdülmecit Yıldız, Sinan Kazan, Mahmut Gök, Erkan Şengül, Murat Tuğçu, Ramazan Ozturk, Serdar Kahvecioğlu, Ekrem Kara, Bülent Kaya, Garip Şahin, Tamer Şakacı, Savaş Sipahi, İlhan Kurultak, Beyza Algül Durak, Mehmet Rıza Altıparmak, Sabahat Alışır Ecder, Serhat Karadağ, Mevlüt Tamer Dinçer, Hakan Özer, Sibel Gökçay Bek, Memnune Sena Ulu, Özkan Güngör, Elif Ari Bakir, Ali Rıza Odabaş, Nurhan Seyahi, Alaattin Yıldız, Kenan Ateş
Abstract
Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively. Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group. Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality. Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients.