Vol 17, No 1 (2024)
Review paper
Published online: 2024-04-02

open access

Page views 90
Article views/downloads 48
Get Citation

Connect on Social Media

Connect on Social Media

The consequences of the COVID-19 pandemic among hemodialysis patients

Aleksander Och1, Leszek Tylicki1
DOI: 10.5603/rdatf.98363
Renal Disease and Transplantation Forum 2024;17(1):1-10.


The outbreak of the COVID-19 pandemic in late 2019 and early 2020 came abruptly causing a significant challenge to the entire world. The number of infections and deaths reached unprecedented levels. Among the most vulnerable to infection and death were patients undergoing chronic hemodialysis, who, on one hand, could not limit their social interactions, and on the other hand, were burdened with numerous coexisting diseases and exhibited compromised immune systems. The development of the first vaccines and the prioritized vaccination against COVID-19 for almost the entire dialysis population saved thousands of patients. The pandemic period, despite its immense tragedy, offers valuable lessons for the future, both in terms of established response strategies and temporary precautionary measures, as well as in reinforcing the conviction of how effective vaccinations are in overcoming infectious diseases, especially in a population as vulnerable as dialysis patients. In this paper, we summarize this challenging period, largely based on our own research conducted at the dialysis center in Gdańsk.

Article available in PDF format

View PDF Download PDF file


  1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022; 12(1): 7–11.
  2. Anderson S, Halter JB, Hazzard WR, et al. workshop participants. Prediction, progression, and outcomes of chronic kidney disease in older adults. J Am Soc Nephrol. 2009; 20(6): 1199–1209.
  3. Dębska-Ślizień A, Rutkowski B, Jagodziński P, et al. Current status of renal replacement therapy in Poland in 2022. Nefrologia i dializoterapia polska. 2022;26(3-4. : 21–38.
  4. Kato S, Chmielewski M, Honda H, et al. Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol. 2008; 3(5): 1526–1533.
  5. Stenvinkel P, Ketteler M, Johnson RJ, et al. IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia--the good, the bad, and the ugly. Kidney Int. 2005; 67(4): 1216–1233.
  6. Kimmel PL, Phillips TM, Simmens SJ, et al. Immunologic function and survival in hemodialysis patients. Kidney Int. 1998; 54(1): 236–244.
  7. Cha J, Han D. Health-Related quality of life based on comorbidities among patients with end-stage renal disease. Osong Public Health Res Perspect. 2020; 11(4): 194–200.
  8. Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: an overview. J Chin Med Assoc. 2020; 83(3): 217–220.
  9. Bernard Stoecklin S, Rolland P, Silue Y, et al. Investigation team. First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures, January 2020. Euro Surveill. 2020; 25(6).
  10. Holshue ML, DeBolt C, Lindquist S, et al. Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020; 382(10): 929–936.
  11. Wu F, Zhao Su, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020; 579(7798): 265–269.
  12. Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020; 7(1): 11.
  13. Jackson CB, Farzan M, Chen B, et al. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol. 2022; 23(1): 3–20.
  14. Wang Y, Wang Y, Luo W, et al. A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells. Int J Med Sci. 2020; 17(11): 1522–1531.
  15. Harvey W, Carabelli A, Jackson B, et al. SARS-CoV-2 variants, spike mutations and immune escape. Nature Reviews Microbiology. 2021; 19(7): 409–424.
  16. Lin L, Liu Y, Tang X, et al. The Disease Severity and Clinical Outcomes of the SARS-CoV-2 Variants of Concern. Frontiers in Public Health. 2021; 9.
  17. Mortality risk of COVID-19 - our world in data. https://ourworldindata.org/mortality-risk-covid (01.04.2023).
  18. Pustake M, Tambolkar I, Giri P, et al. SARS, MERS and CoVID-19: An overview and comparison of clinical, laboratory and radiological features. J Family Med Prim Care. 2022; 11(1): 10–17.
  19. WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. https://covid19.who.int/ (01.04.2023).
  20. Raport zakażeń koronawirusem (SARS-CoV-2) - Koronawirus: informacje i zalecenia. https://www.gov.pl/web/koronawirus/wykaz-zarazen-koronawirusem-sars-cov-2 (28.10.2023).
  21. Biedunkiewicz B, Dębska-Ślizień A, Tylicki L. COVID‑19 in patients requiring renal replacement therapy: an overview of current data and future challenges. Pol Arch Intern Med. 2022; 132(9).
  22. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020; 584(7821): 430–436.
  23. Puchalska-Reglińska E, Dębska-Ślizień A, Biedunkiewicz B, et al. Extremely high mortality rates among hemodialysis patients with COVID-19 before the era of SARS-CoV-2 vaccination: results from a large database from the North of Poland. Pol Arch Intern Med. 2021; 131(7-8): 643–648.
  24. Dębska-Ślizień A, Rutkowski B, Jagodziński P, et al. Current status of renal replacement therapy in Poland in 2020. Nefrologia i dializoterapia polska. 2021; 25(1): 7–20.
  25. Dębska-Ślizień A, Rutkowski B, Jagodziński P, et al. Current status of renal replacement therapy in Poland in 2021. Nefrologia i dializoterapia polska. 2021; 25(4): 85–103.
  26. Biedunkiewicz B, Dębska-Ślizień A, Tylicki L. COVID‑19 in patients requiring renal replacement therapy: an overview of current data and future challenges. Pol Arch Intern Med. 2022; 132(9).
  27. Goicoechea M, Sánchez Cámara LA, Macías N, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020; 98(1): 27–34.
  28. Petrulewicz A, Rydzewska-Rosołowska A, Fiderkiewicz B, et al. The clinical course and short-term outcomes of coronavirus disease 2019 in a cohort of hemodialysis patients. Pol Arch Intern Med. 2020; 130(9): 809–812.
  29. Turgutalp K, Ozturk S, Arici M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19. BMC Nephrol. 2021; 22(1): 29.
  30. Tylicki P, Polewska K, Och A, et al. Angiotensin converting enzyme inhibitors may increase while active vitamin d may decrease the risk of severe pneumonia in sars-cov-2 infected patients with chronic kidney disease on maintenance hemodialysis. Viruses. 2022; 14(3).
  31. Marcinkowski W, Zuzda K, Zawierucha J, et al. Vaccination and COVID-19 in polish dialysis patients: results from the european clinical dialysis database. Vaccines (Basel). 2022; 10(9).
  32. Alberici F, Delbarba E, Manenti C, et al. A report from the brescia renal COVID task force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection. Kidney Int. 2020; 98(1): 20–26.
  33. Couchoud C, Bayer F, Ayav C, et al. French REIN registry. Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients. Kidney Int. 2020; 98(6): 1519–1529.
  34. Taji L, Thomas D, Oliver MJ, et al. COVID-19 in patients undergoing long-term dialysis in Ontario. CMAJ. 2021; 193(8): E278–E284.
  35. De Meester J, De Bacquer D, Naesens M, et al. NBVN Kidney Registry Group. Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy: a regionwide registry study. J Am Soc Nephrol. 2021; 32(2): 385–396.
  36. Bell S, Campbell J, McDonald J, et al. Scottish Renal Registry. COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry. BMC Nephrol. 2020; 21(1): 419.
  37. Weiss S, Bhat P, Del Pilar Fernandez M, et al. COVID-19 infection in ESKD: findings from a prospective disease surveillance program at dialysis facilities in new york city and long island. J Am Soc Nephrol. 2020; 31(11): 2517–2521.
  38. Pio-Abreu A, do Nascimento MM, Vieira MA, et al. High mortality of CKD patients on hemodialysis with Covid-19 in Brazil. J Nephrol. 2020; 33(5): 875–877.
  39. Hilbrands LB, Duivenvoorden R, Vart P, et al. ERACODA Collaborators. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrol Dial Transplant. 2020; 35(11): 1973–1983.
  40. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020; 584(7821): 430–436.
  41. Kowalska M, Barański K, Brożek G, et al. COVID-19-related risk of in-hospital death in Silesia, Poland. Pol Arch Intern Med. 2021; 131(4): 339–344.
  42. Nguyen NT, Chinn J, De Ferrante M, et al. Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS One. 2021; 16(7): e0254066.
  43. Tylicki L, Puchalska-Reglińska E, Tylicki P, et al. Predictors of mortality in hemodialyzed patients after sars-cov-2 infection. J Clin Med. 2022; 11(2).
  44. Ray JG, Schull MJ, Vermeulen MJ, et al. Association between ABO and rh blood groups and sars-cov-2 infection or severe COVID-19 illness : a population-based cohort study. Ann Intern Med. 2021; 174(3): 308–315.
  45. Kibler M, Dietrich L, Kanso M, et al. Risk and severity of COVID-19 and ABO blood group in transcatheter aortic valve patients. J Clin Med. 2020; 9(11).
  46. Dentali F, Sironi AP, Ageno W, et al. Non-O blood type is the commonest genetic risk factor for VTE: results from a meta-analysis of the literature. Semin Thromb Hemost. 2012; 38(5): 535–548.
  47. Campi I, Gennari L, Merlotti D, et al. Vitamin D and COVID-19 severity and related mortality: a prospective study in Italy. BMC Infect Dis. 2021; 21(1): 566.
  48. Güven M, Gültekin H. The effect of high-dose parenteral vitamin D on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study. Eur J Clin Nutr. 2021; 75(9): 1383–1388.
  49. Lakkireddy M, Gadiga SG, Malathi RD, et al. Impact of daily high dose oral vitamin D therapy on the inflammatory markers in patients with COVID 19 disease. Sci Rep. 2021; 11(1).
  50. Förster C, Colombo MG, Wetzel AJ, et al. Persisting symptoms after COVID-19. Dtsch Arztebl Int. 2022; 119(10): 167–174.
  51. Shah W, Hillman T, Playford ED, et al. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ. 2021; 372: n136.
  52. Och A, Tylicki P, Polewska K, et al. Persistent post-covid-19 syndrome in hemodialyzed patients-a longitudinal cohort study from the north of poland. J Clin Med. 2021; 10(19).
  53. Huang L, Yao Q, Gu X, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398(10302): 747–758.
  54. Ozturk S, Turgutalp K, Arici M, et al. The longitudinal evolution of post-covid-19 outcomes among hemodialysis patients in turkey. Kidney Int Rep. 2022; 7(6): 1393–1405.
  55. Chawki S, Buchard A, Sakhi H, et al. Long-term impact of COVID-19 among maintenance haemodialysis patients. Clin Kidney J. 2022; 15(2): 262–268.
  56. Polack FP, Thomas SJ, Kitchin N, et al. C4591001 Clinical Trial Group. Safety and efficacy of the bnt162b2 mRNA covid-19 vaccine. N Engl J Med. 2020; 383(27): 2603–2615.
  57. Baden L, Sahly HEl, Essink B, et al. Efficacy and safety of the mRNA-1273 sars-cov-2 vaccine. New England Journal of Medicine. 2021; 384(5): 403–416.
  58. Polewska K, Tylicki P, Biedunkiewicz B, et al. Safety and tolerability of the bnt162b2 mRNA COVID-19 vaccine in dialyzed patients. COViNEPH project. Medicina (Kaunas). 2021; 57(7).
  59. Litjens NH, Huisman M, van den Dorpel M, et al. Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients. J Am Soc Nephrol. 2008; 19(8): 1483–1490.
  60. Tylicki L, Biedunkiewicz B, Dąbrowska M, et al. Humoral response to SARS-CoV-2 vaccination promises to improve the catastrophic prognosis of hemodialysis patients as a result of COVID-19: the COViNEPH Project. Pol Arch Intern Med. 2021; 131(9): 797–801.
  61. Grupper A, Sharon N, Finn T, et al. Humoral response to the pfizer bnt162b2 vaccine in patients undergoing maintenance hemodialysis. Clin J Am Soc Nephrol. 2021; 16(7): 1037–1042.
  62. Yen JS, Wang IK, Yen TH. COVID-19 vaccination and dialysis patients: why the variable response. QJM. 2021; 114(7): 440–444.
  63. Biedunkiewicz B, Tylicki L, Puchalska-Reglińska E, et al. SARS-CoV-2 infection in vaccinated maintenance hemodialysis patients despite anti-spike seroconversion: a report of 3 breakthrough cases. European Journal of Translational and Clinical Medicine. 2022; 5(1): 12–16.
  64. Sibbel S, McKeon K, Luo J, et al. Real-World effectiveness and immunogenicity of BNT162B2 and mRNA-1273 sars-cov-2 vaccines in patients on hemodialysis. J Am Soc Nephrol. 2022; 33(1): 49–57.
  65. Ashby DR, Caplin B, Corbett RW, et al. Pan-London COVID-19 Renal Audit Group. Severity of COVID-19 after vaccination among hemodialysis patients: an observational cohort study. Clin J Am Soc Nephrol. 2022; 17(6): 843–850.
  66. Esposito P, Picciotto D, Cappadona F, et al. The evolving scenario of COVID-19 in hemodialysis patients. Int J Environ Res Public Health. 2022; 19(17).
  67. Torres R, Toro L, Sanhueza ME, et al. Clinical efficacy of sars-cov-2 vaccination in hemodialysis patients. Kidney Int Rep. 2022; 7(10): 2176–2185.
  68. Tylicki L, Biedunkiewicz B, Puchalska-Reglińska E, et al. COVID-19 vaccination reduces mortality in patients on maintenance hemodialysis. Front Med (Lausanne). 2022; 9: 937167.
  69. Gao P, Liu J, Liu M. Effect of COVID-19 vaccines on reducing the risk of long COVID in the real world: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022; 19(19).
  70. Tang H, Tian JB, Dong JW, et al. Serologic detection of sars-cov-2 infections in hemodialysis centers: a multicenter retrospective study in wuhan, china. Am J Kidney Dis. 2020; 76(4): 490–499.e1.
  71. Chemaitelly H, Ayoub HH, AlMukdad S, et al. Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study. Lancet Microbe. 2022; 3(12): e944–e955.
  72. Bobrovitz N, Ware H, Ma X, et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis. 2023; 23(5): 556–567.
  73. Barouch DH. Covid-19 Vaccines - Immunity, Variants, Boosters. N Engl J Med. 2022; 387(11): 1011–1020.
  74. Basile C, Combe C, Pizzarelli F, et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant. 2020; 35(5): 737–741.
  75. Noordzij M, Meijers B, Gansevoort RT, et al. ERACODA collaborators. Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe-lessons for the future. Clin Kidney J. 2023; 16(4): 662–675.
  76. Biedunkiewicz B, Tylicki L, Puchalska-Reglińska E, et al. Analysis of experiences in preventing COVID-19 in hemodialysis centers of the north of poland before the era of vaccination. Int J Environ Res Public Health. 2022; 19(2).
  77. Rincón A, Moreso F, López-Herradón A, et al. The keys to control a COVID-19 outbreak in a haemodialysis unit. Clin Kidney J. 2020; 13(4): 542–549.
  78. Gan L, Yang B, Wang Y, et al. COVID-19 prevention and control in dialysis centers during the pandemic: a single-center experience. Blood Purif. 2022; 51(2): 193–198.
  79. Chen TH, Wen YH, Chen CF, et al. The advantages of peritoneal dialysis over hemodialysis during the COVID-19 pandemic. Semin Dial. 2020; 33(5): 369–371.

Renal Disease and Transplantation Forum