Clinical, functional, and mental outcomes in hemodialysis patients 3 months after COVID-19 diagnosis

Background: There is overwhelming evidence that hemodialysis (HD) patients are at high risk of death in the first month after developing COVID-19. However, less is known about their long-term mortality risk and functional and mental outcome. We aimed to assess these outcomes in a large cohort of HD patients 3 months after COVID-19 diagnosis. Methods: From ERACODA, we included adult HD patients who presented with COVID-19 from February 1, 2020-January 31, 2021 and with complete data on vital status and hospitalization. Recovery of functional and mental status was estimated by the treating nephrologist. Logistic regression was used to calculate odds ratios (OR) with 95% confidence interval (95%CI) for the likelihood of reaching the pre-COVID-19 status. Results: A total of 2,249 HD patients (mean age 67.5 ± 14.4 years) were included, of whom 1,087 (44%) were not hospitalized, 1,165 (48%) were hospitalized but not admitted to an ICU, and 197 (8%) were hospitalized and ICU-admitted. In these 3 groups, the survival probability at day 28 was 90%, 75% and 47%, and at 3 months 90%, 73% and 40%, respectively. For 854 patients who survived 3 months after COVID-19 diagnosis, data on functional and mental status was available. 743 (87%) reached their pre-COVID-19 functional status within 3 months. 111 patients had not yet reached this, but it was expected that 58% of them would do so within 1 year. Higher age (adjusted OR: 0.97;95%CI: 0.96-0.99), higher frailty score (0.81;0.70-0.93) and ICU admission (0.11;0.05-0.26) were associated with a lower likelihood of reaching pre-COVID-19 functional status. Pre-COVID-19 mental status was reached by 803 (94%) patients. Higher frailty score (0.76;0.65-0.89) and ICU admission (0.27;0.11-0.67) were associated with lower likelihood of reaching prior mental status. For 56% of the 51 patients who had not yet reached their prior status, it was expected that they would do so within the coming year. Conclusions: Three months after a COVID-19 diagnosis, most HD patients who were not admitted to the ICU were still alive. Furthermore, a vast majority had already reached their pre-COVID-19 functional and mental status at that time point.