COVID-19 Impact on Hemodialysis and Kidney Disease Management

The emergence of COVID-19 posed an acute challenge to the management of chronic kidney disease and haemodialysis services worldwide. Patients receiving in-centre haemodialysis are at elevated risk of severe SARS-CoV-2 infection due to frequent healthcare contacts, underlying immunocompromise and high burden of cardiovascular comorbidities. The pandemic prompted rapid adaptation of care pathways, including cohorting of infected individuals, enhanced infection prevention measures and integration of telehealth for pre-session triage. Mortality among dialysis recipients has been reported at 20–30 per cent within 28 days of infection, with heightened risk in older patients and those with heart failure. In parallel, studies have identified prolonged inflammatory responses and increased incidence of thromboembolic events, driving refinements in anticoagulation protocols. Ongoing research focuses on optimising vaccine strategies, identifying immunological biomarkers for long-COVID syndromes and developing tailored therapeutics. Lessons learned during the crisis are reshaping resilient kidney care frameworks and strengthening global collaborations to safeguard this vulnerable population in future health emergencies.

Research from Nature Portfolio

A 2024 cross-sectional study of patients undergoing maintenance haemodialysis examined the interplay between pre-infection blood pressure control and long-COVID manifestations. Elevated levels of interleukin-6 and interleukin-17 were significantly higher in individuals with uncontrolled hypertension compared to those with well-managed blood pressure. Moreover, patients experiencing persistent post-COVID symptoms exhibited prolonged elevation of these cytokines, which gradually declined over five to ten months. These findings implicate IL-6 and IL-17 as potential biomarkers and therapeutic targets linking vascular dysregulation to long-term COVID-19 sequelae in the dialysis population.

COVID-19 Impact on Hemodialysis and Kidney Disease Management publication trend

The graph below shows the total number of articles in covid-19 impact on hemodialysis and kidney disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Haemodialysis: A renal replacement procedure removing waste products and excess fluid from the bloodstream via a dialyser.

Chronic kidney disease (CKD): Progressive loss of kidney function over months or years, often staged by glomerular filtration rate.

Cytokine: Small protein mediators secreted by immune cells that regulate inflammation and immune responses.

Interleukin-6 (IL-6): A pro-inflammatory cytokine involved in acute-phase reactions and chronic inflammation.

Interleukin-17 (IL-17): A cytokine produced by T helper 17 cells that contributes to host defence and inflammatory pathology.

Lymphopenia: A decrease in lymphocyte count in peripheral blood, indicating immunosuppression or immune activation.

References

1. Hemodialysis-Associated Immune Dysregulation in SARS-CoV-2-Infected End-Stage Renal Disease Patients. International Journal of Molecular Sciences (2023).
2. IL-6 and IL-17 as potential links between pre-existing hypertension and long-term COVID sequelae in patients undergoing hemodialysis: a multicenter cross-sectional study. Scientific Reports (2024).
3. Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney International (2020).
4. Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients. Healthcare (2021).