Key result
Prior COVID-19 infection linked to ~2.4-fold higher 24-month mortality in CKD patients.
Why the study?
Chronic kidney disease patients face increased risk for severe COVID-19 outcomes, but the long-term impact of prior infection on survival remains unclear.
Does prior COVID-19 infection increase 24-month all-cause mortality in patients with chronic kidney disease (stages 3-5, including hemodialysis and kidney transplant recipients), and is this relationship mediated by echocardiographic ventricular dysfunction or age?
Cohort (n=239)
No
Does prior COVID-19 infection increase 24-month all-cause mortality in patients with chronic kidney disease (stages 3-5, including hemodialysis and kidney transplant recipients), and is this relationship mediated by echocardiographic ventricular dysfunction or age?
In patients with chronic kidney disease—particularly those on hemodialysis—prior COVID-19 infection is associated with significantly higher 24-month all-cause mortality, an effect partially mediated by right ventricular systolic dysfunction and age, highlighting the value of echocardiographic screening after recovery.
Prior COVID-19 infection was associated with higher CKD mortality; leaves open whether post-recovery echocardiography improves risk stratification.
Background/Objectives: Chronic kidney disease (CKD) patients are at an increased risk for severe outcomes following a COVID-19 infection. However, the long-term impact of prior COVID-19 on survival in this population remains unclear. This study evaluates the association between a prior COVID-19 infection, echocardiographic parameters, and mortality in CKD patients over a 24-month follow-up period. Methods: A prospective cohort study was conducted on 239 CKD patients, including those on hemodialysis. A Kaplan–Meier survival analysis and Cox proportional hazards models were used to assess the impact of COVID-19, age, and comorbidities on the mortality rate. A mediation analysis examined the role of age and the echocardiographic parameters in this relationship. Results: Kaplan–Meier curves demonstrated a significantly lower 24-month survival probability in the COVID-19 group compared to controls (72.5% vs. 87.1%, p = 0.01), particularly in hemodialysis patients (62.5% vs. 83.8%, p = 0.01). In contrast, no significant survival difference was observed in the non-dialysis CKD patients (p = 0.52). A multivariate Cox analysis confirmed age as the key mediator, with COVID-19 losing significance after the age adjustment (p = 0.05). An echocardiographic analysis identified left and right ventricular dysfunction as independent mortality predictors, with right ventricular dysfunction partially mediating the COVID-19–mortality relationship. Conclusions: COVID-19 significantly reduces the survival rate in CKD patients, while left and right dysfunction are strong predictors of mortality. Age partially mediates the relationship between COVID-19 and mortality, but COVID-19 remains an independent risk factor. These findings underscore the need for cardiac function monitoring in post-COVID-19 CKD patients to improve long-term outcomes.
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Vasiliu et al. (2025) conducted a cohort in Chronic kidney disease (stages 3 to 5), including hemodialysis and kidney transplant recipients (n=239). Prior SARS-CoV-2 (COVID-19) infection vs. Age-, sex-, and kidney disease-matched CKD patients without prior confirmed SARS-CoV-2 infection was evaluated on All-cause mortality at 24 months (HR 2.37, 95% CI 1.26-4.45, p=0.01). Prior COVID-19 infection significantly increased 24-month all-cause mortality in CKD patients compared to controls (27.5% vs. 12.8%; HR 2.37, 95% CI 1.26-4.45, p=0.01).
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