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. 2025 Oct 7;14(19):7081.
doi: 10.3390/jcm14197081.

The Impact of COVID-19 on Long-Term Mortality in Maintenance Hemodialysis: 5 Years Retrospective Cohort Study

Ioana Adela Ratiu  1   2 , Lorena Filip  3   4 , Corina Moisa  1 , Cristian Adrian Ratiu  5 , Nicu Olariu  6   7 , Iulia Dana Grosu  6   7 , Gabriel Cristian Bako  1   2 , Andrei Ratiu  8 , Mirela Indries  1   9 , Simona Fratila  1 , Danut Dejeu  1 , Gianina Adela Gabor  10 , Luciana Marc  6   7
Affiliations

The Impact of COVID-19 on Long-Term Mortality in Maintenance Hemodialysis: 5 Years Retrospective Cohort Study

Ioana Adela Ratiu et al. J Clin Med. .

Abstract

Background: Hemodialysis (HD) patients are a highly vulnerable population with elevated mortality driven by comorbidities and dialysis-specific factors. While most studies focused on intra-pandemic outcomes, long-term effects remain underexplored. We aimed to evaluate 5-year mortality and the impact of COVID-19 vaccination in chronic HD patients. Methods: A retrospective study was conducted on 211 HD patients monitored between 2020 and 2024. Outcomes included overall and cardiovascular mortality, risk factors in COVID-19-positive patients, and vaccination impact. Logistic regression identified independent predictors. Results: The cohort had a mean age of 65.6 ± 13.3 years, with 55.9% males and mean dialysis vintage of 6.9 ± 5.5 years. Overall mortality reached 53.6%, while 38.4% were vaccinated. Predictors of all-cause mortality included age (OR = 1.078, p < 0.001), BMI (OR = 0.868, p < 0.001), hemoglobin (OR = 0.581, p < 0.001), phosphorus (OR = 1.351, p = 0.025), dialysis adequacy (OR = 0.138, p = 0.013), and ischemic cardiopathy (OR = 0.327, p = 0.009). In COVID-19-positive patients, mortality was associated with age (OR = 1.069, p = 0.002), low hemoglobin (OR = 0.642, p = 0.014), BMI (OR = 0.885, p = 0.009), CRP (OR = 1.015, p < 0.001), and coronary artery disease (OR = 5.68, p < 0.001). Cardiovascular disease was the leading cause of death (44.6% in COVID-19-positive vs. 73.3% in negatives, p = 0.006). Vaccination significantly reduced COVID-19-related mortality (OR = 0.023, p = 0.005) but did not influence overall or non-COVID mortality. Conclusions: Five-year mortality in HD patients remained high, mainly cardiovascular, and was strongly influenced by age, BMI, hemoglobin, dialysis adequacy, and comorbidities. COVID-19 vaccination substantially reduced COVID-related mortality but did not alter all-cause outcomes. These findings support vaccination and careful risk stratification in HD populations for future pandemics.

Keywords: COVID-19 infection; anti-SARS-CoV2 vaccination; cardiac mortality; hemodialysis; mortality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The imbalance between innate and adaptive immunity. Legend: rhuEPO-recombinant human erythropoietin, CRP-C-reactive protein, TNF-tumor necrosis factor, IL-interleukin, ROS-reactive oxygen species, ET-endothelin, ICAM-intercellular adhesion molecule, VCAM-vascular cell adhesion molecule, MCP-monocyte chemoattractant protein, HMGB-high mobility group box proteins, APC-antigen presenting cells.
Figure 2
Figure 2
Multiple logistic regression evaluating overall mortality.
Figure 3
Figure 3
ROC curve. Predictors of mortality in COVID-19-positive patients.
Figure 4
Figure 4
ROC curve. Multiple logistic regression- COVID-19-related mortality.
Figure 5
Figure 5
ROC curve. Multivariable logistic regression analysis of predictors of cardiovascular mortality.
See this image and copyright information in PMC

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